Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. May 27, 2022; 14(5): 506-513
Published online May 27, 2022. doi: 10.4240/wjgs.v14.i5.506
Aorto-oesophageal fistula after corrosive ingestion: A case report
Matthias Frank Scriba, Urda Kotze, Nadraj Naidoo, Eduard Jonas, Galya Eileen Chinnery
Matthias Frank Scriba, Eduard Jonas, Galya Eileen Chinnery, Surgical Gastroenterology Unit, Department of Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town 7925, Western Cape, South Africa
Urda Kotze, Surgical Gastroenterology Unit, Department of Surgery, University of Cape Town, Faculty of Health Sciences, Cape Town 7925, Western Cape, South Africa
Nadraj Naidoo, Vascular and Endovascular Surgery Unit, Department of Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town 7925, Western Cape, South Africa
Author contributions: Scriba MF, Chinnery GE and Kotze U performed the literature review; Jonas E and Naidoo N assisted in writing up the paper and critically reviewing it; all authors read and approved the final manuscript
Informed consent statement: Informed written consent was obtained from the patient for the publication of this report and for any accompanying images.
Conflict-of-interest statement: The authors declare they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Matthias Frank Scriba, MBChB, Surgeon, Surgical Gastroenterology, Department of Surgery, Groote Schuur Hospital, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, Western Cape, South Africa. matthias.scriba@gmail.com
Received: August 31, 2021
Peer-review started: August 31, 2021
First decision: March 11, 2022
Revised: March 23, 2022
Accepted: April 15, 2022
Article in press: April 15, 2022
Published online: May 27, 2022
Processing time: 266 Days and 18.8 Hours
Abstract
BACKGROUND

Aorto-oesophageal fistula (AOF) are uncommon and exceedingly rare after corrosive ingestion. The authors report a case of AOF after corrosive ingestion that survived. A comprehensive literature review was performed to identify all cases of AOF after corrosive ingestion to determine the incidence of this condition, how it is best managed and what the outcomes are.

CASE SUMMARY

A previously healthy 30-year-old male, presented with a corrosive oesophageal injury after drain cleaner ingestion. He did not require acute surgical resection, but developed long-segment oesophageal stricturing, which was initially managed with cautious dilatation and later stenting. An AOF was suspected at endoscopy performed two months after the ingestion, when the patient represented with massive upper gastrointestinal bleeding. The fistula was confirmed on computerised tomographic angiography. The initial bleeding at endoscopy was temporised by oesophageal stenting; a second stent was placed when bleeding recurred later the same day. The stenting successfully achieved temporary bleeding control, but resulted in sudden respiratory distress, which was found to be due to left main bronchus compression caused by the overlapping oesophageal stents. Definitive bleeding control was achieved by endovascular aortic stent-grafting. A retrosternal gastroplasty was subsequently performed to achieve gastrointestinal diversion to reduce the risk of stent-graft sepsis. He was subsequently successfully discharged and remains well one year post injury.

CONCLUSION

AOF after corrosive ingestion is exceedingly rare, with a very high mortality. Most occur weeks to months after the initial corrosive ingestion. Conservative management is ill-advised.

Keywords: Aorto-oesophageal fistula; Corrosive/caustic injury; Corrosive ingestion; Case report

Core Tip: Aorto-oesophageal fistula (AOF) after corrosive ingestion is exceedingly rare, but is usually catastrophic. We present a case of AOF after corrosive ingestion which was successfully managed with a combination of oesophageal stenting to achieve temporary bleeding control, and endovascular aortic stent-grafting with retrosternal gastroplasty as definitive management. Including this case, only 16 individual cases of this rare condition are found in the literature, with only two survivors prior to this case. Fistula formation usually only occurs weeks to months after the ingestion incident and as such a high level of suspicion is needed to diagnose this illusive and difficult to manage condition.