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A 60-year-old man presented with severe abdominal pain, two episodes of massive haematemesis and chest discomfort. CT angiography showed a saccular aneurysm of the juxtaphrenic aorta with possible oesophageal erosion. Upper GI endoscopy revealed external compression of the lower oesophagus—near total luminal obstruction with impending rupture of the aortic aneurysm. Emergency aneurysmal repair by interposition grafting using 20 mm Dacron graft with oesophageal–gastric reconstruction done. Postoperative period was uneventful

The ideal management of bronchoesophageal fistulas is a debated topic. While open surgical repair remains the most definitive treatment, not all patients are fit for surgery. In this communication, we present a patient who developed a bronchoesophageal fistula 1 year after an Ivor Lewis esophagectomy that involved the native oesophagus and right mainstem bronchus. Endoluminal vacuum therapy was successful at closing this benign bronchoesophageal fistula.

Management of an uncorrected broncho-oesophageal fistula in the perioperative period is a challenge for the anaesthesiologist. Positive pressure ventilation which is inevitable during surgery will lead to gastric insufflation and there is a high risk of aspiration of gastric contents. In this case report, we discuss how we used a double lumen tube to occlude a pericarinal broncho-oesophageal fistula. This method was quite effective as it obviated the need for isolating the lung as well as ensured smooth delivery of positive pressure ventilation during the surgery.

A 79-year-old hypertensive man with chronic type B aortic dissection (TBAD) came with acute chest pain. CT revealed partially thrombosed aneurysmal dilatation of false lumen, compressing trachea and oesophagus (chronic complicated TBAD) with the extremely tortuous descending thoracic aorta ([figures

Objectives The presence of a fistula between the thoracic aorta and the esophagus is a rare and highly fatal condition. This study aimed to evaluate the outcomes of the surgical treatment of an aortoesophageal fistula (AEF). Methods We retrospectively reviewed patients with AEF who underwent surgery at our institution. Results Between 2007 and 2018, a total of 10 patients who underwent surgery for AEF. The mean age was 63 ± 12 years, and 6 patients were men. Four patients had primary AEFs and 6 patients had secondary AEFs (3 graft replacements and 3 thoracic endovascular aortic repairs). The timing of AEF since graft replacement or thoracic endovascular aortic repairs was 21.6 ± 27 days. We performed aortic replacement with a prosthetic graft (4 patients) or a homograft (5 patients) and extra-anatomical bypass due to a previous aortic graft infection (1 patient). As a treatment of the esophagus, we conducted primary repair in 7 of 10 patients. The median lengths of hospital and intensive care unit stay were 59 days (range, 9-225 days) and 6.3 days (range, 1-87 days), respectively. Seven patients achieved oral feeding after a median 10.3 postoperative days (range, 7-78 postoperative days). Two of the 10 patients died of sepsis at 9 and 74 days postoperatively. Conclusions The strategy for patients with AEF should be individualized. Our surgical strategy for AEF, which includes simultaneous aortic graft replacement and primary repair of esophagus in the same operative field, is feasible and promising.

Left atrial-esophageal fistula (AEF) following radiofrequency ablation for atrial fibrillation is a rare and potentially lethal complication. Although surgical management is associated with improved outcomes, the optimal approach remains to be elucidated. We describe a case of AEF which was treated with a simultaneous repair of the atrium and esophagus via a right thoracotomy with an extra-pericardial off-pump approach.

Background Esophageal pleural fistula (EPF) is a rare but fatal complication associated with bevacizumab use; however, cases reports of EPF caused by bevacizumab have not been previously published. Case presentation A 66-year-old male patient diagnosed with stage IV lung adenocarcinoma on April 24, 2020 received 6 cycles of platinum-containing dual chemotherapy combined with bevacizumab followed by three cycles of bevacizumab monotherapy. Five days before admission, he experienced chest tightness, dyspnea, and right chest pain. Bed-side X-ray examination revealed a massive right hydrothorax, and food was found in the extracted pleural effusion. EPF was further confirmed by upper gastrointestinal radiography after oral administration of iohexol. The patient underwent jejunostomy as the distal esophagus could not be identified on gastroscopy, and eventually died of septic shock on January 16, 2021. Conclusions It is necessary to pay attention to EPF during bevacizumab use in patients with or without risk factors.

BACKGROUND Fistula between the esophagus and bronchial artery is an extremely rare and potentially life-threatening cause of acute upper gastrointestinal bleeding. Here, we report a case of fistula formation between the esophagus and a nonaneurysmal right bronchial artery (RBA). CASE SUMMARY An 80-year-old woman with previous left pneumonectomy and recent placement of an uncovered self-expandable metallic stent for esophageal adenocarcinoma was admitted due to hematemesis. Emergent computed tomography showed indirect signs of fistulization between the esophagus and a nonaneurysmal RBA, in the absence of active bleeding. Endoscopy revealed the esophageal stent correctly placed and a moderate amount of red blood within the stomach, in the absence of active bleeding or tumor ingrowth/overgrowth. After prompt multidisciplinary evaluation, a step-up approach was planned. The bleeding was successfully controlled by esophageal restenting followed by RBA embolization. No signs of rebleeding were observed and the patient was discharged home with stable hemoglobin level on postoperative day 7. CONCLUSION This was a previously unreported case of an esophageal RBA fistula successfully managed by esophageal restenting followed by RBA embolization.

BACKGROUND Massive upper gastrointestinal (GI) bleeding is usually urgent and severe, and is mostly caused by GI diseases. Aortoesophageal fistula (AEF) after thoracic aortic stent grafting is a rare cause of this condition, and has a poor prognosis with a high mortality rate. The clinical symptoms of AEF are usually nonspecific, and the diagnosis is often difficult, especially when upper GI bleeding is absent. Early identification, early diagnosis, and early treatment are very important for improving prognosis. CASE SUMMARY A 74-year-old man was admitted to the infectious disease department with > 10-d fever and 10-mo prior history of thoracic aortic stent grafting for thoracic aortic penetrating ulcers. Blood tests revealed elevated inflammatory indicators and anemia. Chest computed tomography (CT) showed postoperative changes of the aorta after endovascular stent graft implantation, pulmonary infection and pleural effusion. Pleural effusion tests showed empyema. After 1 wk of anti-infective treatment, temperature returned to normal and chest CT indicated improvement in pulmonary infection and reduction of pleural effusion. Esophageal endoscopy was performed because of epigastric discomfort, and showed a large ulcer with blood clot in the middle esophagus. However, on day 11, hematemesis and melena developed suddenly. Bleeding stopped temporarily after hemostatic treatment and bedside endoscopic hemostasis. Thoracic and abdominal aortic CT angiography confirmed AEF. Later that day, he suffered massive hemorrhage and hemorrhagic shock. Eventually, his family elected to discontinue treatment. CONCLUSION AEF should be strongly considered in patients with a history of aortic intervention who present with fever, especially with empyema.

Background: Although trachea-esophageal fistula (TEF) and esophageal atresia (EA) is rare, it is one of the most common congenital anomaly. There is paucity of data due to rarity of condition. More and more data on clinical profile, complications, and outcome are needed to guide the future research. Objective: To study clinical profile of newborns with TEF and EA and factors associated with outcome. Materials and Methods: Hospital based prospective study was carried out among 21 newborns with TEF and EA. Diagnosis was confirmed by investigations like X-ray chest after passing nasogastric catheter. Depending upon final diagnosis type of surgery required was determined and procedure was carried out as per the standard guidelines and operating techniques. All cases were followed till the complete post-operative period and the complications and outcome was assessed. Outcome was classified as death or discharge. Results: Males outnumbered females giving a male to female ratio of 2.5:1. 57.1% did not require ventilator pre-operatively. 61.9% of the cases had no associated abnormality. The most common type of surgery required and performed was tracheoesophageal repair in 52.4% of the cases. Two cases (9.5%) died during the post-operative period. 14 cases (66.7%) recovered and were discharged. Most common complication was anastomotic leak (57.1%). Term status and associated abnormalities were not found to be associated with outcome like death (p>0.05). Conclusion: Trachea-esophageal fistula and esophageal atresia was more common in males. Tracheoesophageal repair was commonly required surgery. Recovery rate was good. Anastomotic leak was most common complication. Outcome like death was not associated with term status and associated abnormalities. Keywords: Clinical profile, Newborns, Tracheoesophageal fistula, Atresia, Outcome

Aim: To determine the different factors leading to poor outcome in operated case of esophageal atresia and trachea-esophageal fistula (EA-TEF). Material and Methods: This is a retrospective non-randomized comparative study. All the patient who presented with EA-TEF to us were included in the study. The patients who were not operated and patient who were discharged against the advice were excluded from the study. Patients were divided in to two groups. Group-A- Those who have survived after the surgery-39 and Group-B those who expired after the surgery-38. Various parameters were considered in relation to pre-operative, intra-operative and post-operative factors. To name few antenatal findings, maternal hemoglobin, gestational age, gap between both the end, duration of procedure, need for mechanical ventilation, early start of NG feed, need for blood products and postoperative complications. Results: Preoperative factor which had significant negative impact on survival were antenatally diagnosed polyhydramnios, maternal anemia, gestational age and associated severe cardiac anomalies. Mean operating time was more in group-B. Whenever surgeons or anaesthesiologists decided to continue postoperative ventilation the outcome was poor- 34 needed post-operative ventilation in group-B versus 12 in group A. Need for blood transfusion and need for platelets transfusion did not show significant difference among two groups but the need for plasma transfusion had poor survival. SIRS/sepsis played important determining factor in survival of EA-TEF. Patients who could be fed early, had better survival. Pneumothorax, pneumonia and leak didn’t show significant difference in survival. Conclusion: Different factors before, during and after the surgery have impact on outcome of EA-TEF. We should be able to formulate prognostic score which is based our local needs and available resources.

Objetivos: mostrar la eficacia y seguridad de los stents metálicos autoexpandibles para el manejo endoscópico de las fístulas esofágicas. Materiales y métodos: se evalúo una serie de casos de manera retrospectiva entre el 2007 y el 2017, en los que se manejaron a 11 pacientes con un stent metálico autoexpandible para el manejo de fístula esofágica, en quienes se realizó el diagnóstico por clínica, endoscopia digestiva alta o estudios radiológicos en la unidad de gastroenterología del Hospital Universitario San Ignacio (HUSI) de Bogotá D. C., Colombia. Resultados: el principal síntoma inicial fue la disnea en 27,3 % de los casos, seguido por tos en un 18,2 %. El hallazgo más frecuentemente encontrado durante el seguimiento fue el derrame pleural en el 36,4 %, se realizó el diagnóstico de fístula en el 45,5 % con esofagograma y el tipo de lesión más reportada fue la fuga en la anastomosis esofagoentérica, con un 45,5 %, seguida de la esofagopleural, con un 36,4 %; y estos pacientes fueron manejados con un stent metálico autoexpandible. En el 100 % hubo éxito técnico y la resolución del defecto se evidenció en el 72,7 % de los casos. La única complicación reportada fue el desplazamiento del stent en el 27,3 %, y en un paciente se requirió el cambio del stent en 3 oportunidades. El promedio de estancia hospitalaria fue de 41,5 días. Conclusiones: el manejo endoscópico de las fístulas esofagogástricas con stents metálicos autoexpandibles es efectivo y seguro, con una baja tasa de complicaciones.

Adult, benign, non-iatrogenic bronchoesophageal fistula (BEF) is a rare condition, which is occasionally described in single case reports. Therefore, little is known about its possible causes, presentation and management. A systematic search of the literature in MEDLINE, PubMed Central and EMBASE databases between 1990 and 2020 was carried out to identify all cases of BEF. The initial database search identified 19,452 articles, of which 183 (251 individual patient cases) were included in the final analysis. Main causes of BEF were congenital malformations (97/251, 38.7%) and infections (82/251, 32.7%), while 33/251 (13.1%) fistulae were regarded as idiopathic and 39/251 (15.5%) attributed to other causes. Esophagograpy was the most sensitive method of diagnosis (97.4%) compared with esophagoscopy (78.9%), computed tomography (49.6%) and bronchoscopy (46.0%). Definitive treatment was surgical for 176 patients (70%), endoscopic for 25 (10%) and medical for 37 (14.7%). Compared with congenital BEFs, infective BEFs had shorter median symptom duration and were distributed more proximally over the bronchial tree. Definitive treatment was almost only surgical for congenital BEFs, while infective BEFs were treated also endoscopically (12%) and by medical therapy (38%). Morbidity, treatment failure and recurrence rates were higher for infective BEFs. BEFs are rare. Symptoms are non-specific and a high index of suspicion is necessary for diagnosis. Patients with infective BEF tend to have a more severe clinical picture than those with congenital BEF. Surgery is the main treatment for patients affected by congenital BEF, while infective BEFs may heal conservatively.

Background Esophageal fistulae are rare, though serious, complications of anterior cervical surgery. Hardware-related issues are important etiologic factors. Patient-specific implants (PSIs) have increasingly been adapted to spinal surgery and offer a range of benefits. Zero-profile implants are a recent development primarily aimed at combating postoperative dysphagia. We report the first use of a 3-dimensional (3D)-printed zero-profile PSI in managing implant failure with migration and a secondary esophageal fistula. Methods A 68-year-old female had a prior C5-7 corpectomy with cage and plate fixation, as well as posterior C3-T1 lateral mass fixation, complicated by anterior plate displacement, resulting in pseudoarthrosis and an esophageal fistula. A 3D-printed zero-profile PSI was designed and implanted as part of a revision procedure to assist in recovery, prevent recurrence, and facilitate bony fusion. Results Optimal implant placement was achieved on the basis of preoperative virtual surgical planning. By 1 month postoperatively the patient had significantly improved, with evidence of esophageal fistula resolution and radiographic evidence of optimal implant placement. Conclusions Zero-profile 3D-printed PSIs may combat common and serious complications of anterior cervical surgery including postoperative dysphagia and esophageal fistulae. Further research is required to validate their widespread use for either cervical corpectomy or diskectomy and interbody fusion.

Percutaneous catheter ablation is an established intervention for the treatment of atrial fibrillation (AF). In line with the widespread use of this technique, its complications have also received attention.1,2 Although rare, cardiac tamponade, cerebral embolism, pulmonary vein stenosis, esophageal fistulas, and other serious complications may occur. Gastrointestinal (GI) symptoms related to the upper GI tract, such as esophageal damage/fistula and gastric hypomotility, are well known,3,4 while lower digestive tract symptoms are less known and underestimated. We herein report 3 cases of persistent diarrhea that occurred after catheter ablation for AF.

Background Gastric pull-up (GPU) procedures may be complicated by leaks, fistulas, or stenoses. These complications are usually managed by endoscopy, but in extreme cases multidisciplinary management including reoperation may be necessary. Here, we report a combined endoscopic and surgical approach to manage a failed secondary GPU procedure. Case summary A 70-year-old male with treatment-refractory cervical esophagocutaneous fistula with stenotic remnant esophagus after secondary GPU was transferred to our tertiary hospital. Local and systemic infection originating from the infected fistula was resolved by endoscopy. Hence, elective esophageal reconstruction with free-jejunal interposition was performed with no subsequent adverse events. Conclusion A multidisciplinary approach involving interventional endoscopists and surgeons successfully managed severe complications arising from a cervical esophagocutaneous fistula after GPU. Endoscopic treatment may have lowered the perioperative risk to promote primary wound healing after free-jejunal graft interposition.

Background This study aims to review and compare the clinical presentation, management, and outcome in patients with tumor-related (TR) and nontumor-related (NTR) aorto-esophageal fistula (AEF) and aorto-bronchial fistula (ABF) with particular focus on the thoracic endovascular aortic repair. Methods We retrospectively reviewed a series of 16 consecutive patients with TR (n = 8) and NTR (n = 8), ABF (n = 6), and AEF (n = 10) admitted to our hospital from 2011 to 2019. Results The median age was 62 years (range 46–81), with 11 men. The most common predisposing factor was esophageal or gastric cardia cancer (n = 6), followed by open repair of the thoracic aorta (n = 5). Endoluminal vacuum therapy (Endo-SPONGE®) accounted for 3 cases of AEFs. Thoracic endovascular aortic repair (TEVAR) was applied in 13 patients (4 with ABFs and 9 with AEFs). The primary technical success of the TEVARs was 100%. One patient (8%) was complicated with postoperative middle cerebral artery syndrome and left-sided hemiparesis. The respective in-hospital, 6-month, and 1-year mortality rates were 0% (n = 0), 25% (n = 2), and 25% (n = 2) for the NTR group and 63% (n = 5), 88% (n = 7), and 100% (n = 8) for the TR group. After a mean period of 13 months, 5 (31%) patients were still alive, and one patient lost to follow-up after 11 months. The survivors (n = 5) had all nontumor-related ABF. Progression of underlying cancer and hemodynamic shock were the most common causes of death. Conclusions TEVAR represents a reliable option in the treatment of NTR ABFs. In the cases of TR fistulas and NTR AEFs, TEVAR should be applied more selectively. The associated mortality remains very high.

Aortic esophageal fistula (AEF) is a rare but extremely life-threatening condition requiring immediate surgical treatment. The mortality rate among such patients may exceed 60 %, including after surgical treatment. Etiological and pathogenetic mechanisms of AEF are complex and various, but in most cases, they are associated with chronic aortic diseases. The second group of etiological factors of AEF includes trauma of esophagus wall by foreign bodies, malignant neoplasms of the esophagus or mediastinum. AEF may also occur as a result of surgical interventions on the aorta and esophagus. The difficulties of early diagnosis are primarily associated with non-specific clinical manifestations of AEF and the lack of unified protocol for the examination of patients with the first-time upper gastrointestinal tract bleeding. The described reasons in some cases can lead to an inaccurate diagnosis, which entails a loss of time. Among the instrumental diagnostic methods, the most informative is the combination of esophagogastroduodenoscopy and computed tomography of the chest with intravenous contrast enhancement. Each of these methods has its advantages and disadvantages, and allows to identify a number of direct and indirect signs of pathological communication between the aorta and the esophagus.

Thoracoscopic Repair of Esophageal Atresia with Tracheoesophageal Fistula (TREAT) is now an established procedure. The anastomosis performed thoracoscopically is always compared to the hand sewn anastomosis in open surgery. The present study analyses the outcome of TREAT versus open repair in terms of radiological index representing the esophageal calibre. Patients with esophageal atresia-tracheoesophageal fistula (EA-TEF) operated by open repair and TREAT were evaluated. An esophageal calibre anastomotic index (EACI) was formulated based on measurements performed on contrast esophagogram at 3 months or later. The diameter of the esophagus at the level of anastomosis was measured, along with ratios of radiologically measured values both above and below the anastomosis; based on which an index was calculated. A value closer to 1 was considered normal, whereas a ratio

We present a case of a port malposition into the azygos vein resulting in both a broncho-esophageal and veno-bronchial fistula. While complications of central venous catheter malposition into the azygos vein are well documented in literature, these unique complications have not yet been described. This case underscores how utilizing state of the art technology like intra-cavity electrocardiography rather that reliance on fluoroscopy can help eliminate catheter malposition and its potential catastrophic consequences.

Endoscopic esophageal stent implantation is an effective method for dysphagia management in malignant esophageal stricture. However, this technology is associated with the risk of many complications, including those fatal to life. These include bleeding, restenosis, stent fragmentation and destruction, stent migration, pneumomediastinum, the formation of esophageal fistulas, perforations, clogging of the stent with food, retrosternal pain, gastroesophageal reflux changes, airway compression, aspiration pneumonia, and fever. The overall complication rate is 3640%. Mortality rates associated with stenting is between 3.9 and 27.2%. Nevertheless, today there are ways to minimize the incidence of complications due to the constant progress of endoscopic technologies and improvements in the design of modern stents. In addition, most endoscopic interventions can manage the vast majority of complications effectively after stent implantation subject to their early detection. Optimal selection of an esophageal stent and careful selection of patients with a low risk of complications associated with stent implantation are important problems in the prevention of complications to achieve high efficiency of stenting. Evaluation of risk factors for possible complications, the design of stents and their characteristics, as well as using modern methods of effective management of possible complications improves the quality and duration of life in incurable patients with esophageal cancer. The review reflects all possible complications of stenting in esophageal and gastroesophageal junction, factors affecting the occurrence of complications, as well as modern and effective methods of their correction and prevention.