背景:主动脉食管瘘可能是致命的。在治疗无自发性闭合的主动脉食管瘘的同时,应考虑挽救胸主动脉腔内修复术作为桥接疗法和开胸手术的根治性手术。此外,选择一种降低再感染风险的技术至关重要。在这里,我们报告了一个罕见的病例,破裂的胸主动脉瘤与食道穿孔有关,鱼骨导致大量呕血和休克。以及抢救胸主动脉腔内修复后发展的主动脉食管瘘的手术治疗。
方法:一名70岁的日本女性患者因呕血入院,胸痛,与1个月前鱼骨抽吸和食管穿孔引起的破裂降主动脉瘤的食管穿孔有关的休克。进行了紧急的胸主动脉腔内修复术。术后,观察到主动脉食管瘘保持开放,并且与食物摄入相关的炎症反应增加.行根治性血管假体植入和瘘管闭合术。患者术后病程良好,血管假体植入22天后出院。
结论:这种与鱼骨穿孔和主动脉食管瘘相关的降主动脉瘤破裂的病例相当罕见。因此,我们报告了这个特殊病例的治疗策略并回顾了相关文献.
BACKGROUND: An aortoesophageal fistula can prove to be fatal. Salvage thoracic endovascular aortic repair as a bridging therapy and radical surgery with thoracotomy should be considered while treating aortoesophageal fistula without spontaneous closure. Moreover, it is essential to select a technique that reduces the risk of reinfection. Here we report a rare case of a ruptured thoracic aortic aneurysm related to esophageal perforation by a fish bone that led to massive hematemesis and shock, and the surgical treatment of an aortoesophageal fistula that developed after salvage thoracic endovascular aortic repair.
METHODS: A 70-year-old Japanese female patient was admitted with hematemesis, thoracic pain, and shock related to esophageal perforation of a ruptured descending aortic aneurysm caused by fish bone aspiration and esophageal perforation 1 month previously. An emergency thoracic endovascular aortic repair was performed. Postoperatively, an aortoesophageal fistula that remained open and a food intake-related increase in the inflammatory response was noted. Radical blood-vessel prosthesis implantation and fistula closure were performed. The patient\'s postoperative course was favorable and the patient was discharged 22 days after the blood vessel prosthesis implantation.
CONCLUSIONS: Such a case of rupture of a descending aortic aneurysm related to perforation by a fish bone and an aortoesophageal fistula is considerably rare. Thus, we report the therapeutic strategy of this particular case and review the relevant literature.