Surgical management of aortoesophageal fistula caused by foreign bodies

Abstract

Objective: Aortoesophageal fistula (AEF) is a rare complication of foreign-body ingestion but is often life threatening.

Methods: Between July 2006 and July 2009, four patients (two male and two female, age between 54 and 62 years old) with AEF were treated in our center. Cardiopulmonary bypass was established in all cases. The infected aorta was resected and replaced with aortic Dacron graft. The esophagus was mobilized and removed, and the digestive tract was reconstructed 1-2 months later after the first operation, by performing anastomosis of the esophagus and stomach at the neck.

Results: All four cases were treated successfully and survived up to the days when this article was written.

Conclusions: It might be a safer way to perform this surgery under cardiopulmonary bypass. Thorough surgical debridement should be done, including resection of thoracic esophagus, adequate irrigation and flushing, and full draining of the chest cavity. Reconstruction of the digestive tract in the second stage of this two-stage operation should be the safest choice.