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Cause of mortality in aortoesophageal fistula: oesophageal sepsis. A case report

Ulaş Aday, Durmuş Ali Çetin, Hüseyin Çiyiltepe, Ebubekir Gündeş, Emre Bozdağ, Aziz Serkan Senger

Data publikacji online: 2017/09/30
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Aortoesophageal fistula (AEF) is a rare condition, which causes massive upper gastrointestinal system bleeding [1]. The most frequent cause of primary AEF is thoracic aortic aneurysm, which is engendered by such causes as the rupture of penetrating aortic ulcer, foreign body swallowing, thoracic trauma, oesophageal cancer, and bronchogenic carcinoma. Secondary AEF, on the other hand, is frequently caused by surgical procedures done by graft because of aortic aneurysms or neighbouring organ surgeries [2, 3]. Emergency surgical procedures to treat life-threatening massive bleeding following AEF have a high risk of mortality. Therefore, thoracic endovascular aortic repair (TEVAR) has recently become a popular and effective method [4]. It has been reported that the most significant clinical condition affecting patients’ long-term survival following the achievement of bleeding control through TEVAR was continuing oesophageal fistula and the related sepsis secondary to mediastinitis. Thus, it has been suggested that definitive surgical procedures to treat the oesophagus should be performed without delay following the stabilisation of the patient [5]. The surgical procedure to be performed varies according to the underlying causes. The control of the continuing infection and the related sepsis has been considered to be the Achilles’ heel of treatment [6].
This study presents the case of a patient with AEF, whose bleeding control was achieved through TEVAR, but who died of oesophageal sepsis. The goal of the study is to underline the significance of the oesophagus in clinical profile and the control of the source of infection in order to decrease the rate of mortality.
A 59-year-old female patient had been evaluated at a different centre because of haematemesis, which had started three days earlier, and had been referred to our hospital’s cardiovascular surgery clinic diagnosed with AEF. The patient, who had a history of diabetes for about 25 years, had no history of surgery. The first clinical evaluation of the patient revealed arterial blood pressure level of 108/68 mm Hg, heart rate of 112 min–1, and a normal neurological examination result. Her rectal evaluation showed melena. The patient was taken into intensive care and was monitored. Her laboratory results were as follows: hematocrit 22.4% (normal range: 33–54%), hemoglobin 7.8 g/dl (normal range: 11.1–17.1 g/dl), urea 100 mg/dl (normal range: 10–50 mg/dl), albumin 1.87 g/dl...

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