背景:主动脉食管瘘(AEF)是一种罕见的疾病,其特征是主动脉和食管之间的交流。由食道异物引起的AEF甚至很少见,目前尚无推荐的标准治疗方案。我们报告了一例在内镜下摘除鱼骨后延迟的主动脉破裂,血管支架置入术和胸外科手术联合治疗成功。
方法:一名33岁男子在意外摄入鱼骨后出现胸部不适3天后到医院就诊。在内窥镜引导下,鱼骨被成功移除,患者随后入院接受药物治疗。术后第四天,病人突然吐血,胸部计算机断层扫描血管造影显示存在AEF。这需要紧急干预;因此,进行了胸外科手术,并放置了血管覆膜支架.手术后,病人接受了积极的治疗,恢复良好,并顺利出院。
结论:异物引起的食管穿孔患者,住院观察,计算机断层扫描血管造影检查,早期使用抗生素,建议仔细评估主动脉损伤。胸主动脉腔内修复术和食管破裂修复术可能对AEF的治疗有益。
BACKGROUND: Aortoesophageal fistula (AEF) is a rare condition characterized by communication between the aorta and esophagus. AEF caused by an esophageal foreign body is even rare, and there is currently no recommended standard treatment protocol. We report a case of delayed aortic rupture after the endoscopic removal of a fish bone, which was successfully treated with a combined approach of vascular stenting and thoracic surgery.
METHODS: A 33-year-old man presented to the hospital after experiencing chest discomfort for 3 days following the accidental ingestion of a fish bone. Under endoscopic guidance, the fish bone was successfully removed, and the patient was subsequently admitted for medical therapy. On the fourth postoperative day, the patient suddenly developed hematemesis, and chest computed tomography angiography revealed the presence of an AEF. This necessitated urgent intervention; hence, thoracic surgery was performed and a vascular-covered stent was placed. Following the surgical procedure, the patient received active medical treatment, recovered well, and was successfully discharged from the hospital.
CONCLUSIONS: In patients with esophageal perforation caused by foreign bodies, hospitalization for observation, computed tomography angiography examination, early use of antibiotics, and careful assessment of aortic damage are advised. Thoracic endovascular aortic repair and esophageal rupture repair may have benefits for the treatment of AEF.