Fatal complications of aortoesophageal fistula caused by pseudoaneurysm following esophageal stent placement: A case report
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Rationale: Aortoesophageal fistula (AEF) is an exceedingly rare yet critically life-threatening condition, with mortality rates nearing 100% if not addressed promptly. AEF often develops in the context of thoracic aortic aneurysms, esophageal malignancies, or as a complication of foreign body ingestion and prior thoracic aortic surgeries. This study reports an exceptionally severe and clinically rare case of AEF associated with a pseudaneurysm induced by esophageal stenting. By disseminating this case, we aim to heighten awareness of AEF and emphasize the necessity for meticulous decision-making during esophageal stent placement, along with the importance of vigilant postoperative monitoring to enable early intervention. Patient concerns: A 70-year-old male presented with “food obstruction” and was subsequently diagnosed with esophageal malignancy. To alleviate the obstruction, he underwent esophageal stenting. Fifty-five days postprocedure, he experienced a sudden onset of “chest pain, vomiting of dark red blood, and melena,” prompting hospitalization for “gastrointestinal bleeding.” Diagnoses: Urgent computed tomography angiography revealed the emergence of a new pseudaneurysm at the lateral aspect of the esophageal stent, with direct communication between the aneurysm and the adjacent esophagus, raising the suspicion of AEF. Interventions: An urgent multidisciplinary emergency team was convened to execute critical interventions, including endoluminal stenting of the esophagus and thoracic endovascular aortic repair. Outcomes: The patient suffered a sudden and massive hematemesis, estimated at approximately 3000 mL, leading to his subsequent demise. Lessons: AEF is a rare cause of upper gastrointestinal bleeding. For patients suspected of AEF, it is imperative to conduct prompt and thorough computed tomography angiography while initiating an emergency surgical alert. The proximity of esophageal stents to the aorta may significantly elevate the risk of AEF; thus, a comprehensive risk assessment should precede stent placement in cases involving tumors adjacent to the aorta. Furthermore, postoperative surveillance is crucial to monitor potential aortic invasion by the tumor or the development of an aneurysm near the esophagus, facilitating timely intervention.Keywords:
Pseudoaneurysm
Esophageal stricture
Upper Gastrointestinal Bleeding
Objective To study the effects of isoniazid on the prevention of benign stricture of the esophagus. Methods The study was divided into 2 parts: In the first of animal experimentation, 20 dogs were divided into group A (normal; n =6), group B (positive control, n =6) and group C (isoniazid treated, n =8). The dogs of group B and C were inflicted with alkali burns of the esophagus and those of group C were treated with isoniazid. 8 weeks later, all the dogs were killed to measure the diameter of the stricture and the compliance and collagen content of the esophagus. In the second part, 26 patients with benign stricture of the esophagus were treated with isoniazid after esophageal dilatation. Results In the dogs inflicted with esophageal burns, isoniazid showed an obvious effect of inhibition on the formation of collagen in the esophagus. The diameter of esophageal stricture was significantly larger and the esophageal complicance markedly better in group C than in group B ( P 0.01). In the clinical study, satisfactory result was obtained in 24 cases and the other 2 dropped out of our follow up. Conclusion Isoniazid can prevent benign stricture of the esophagus and is worthy to be further tried clinically.
Esophageal stricture
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Splenic artery pseudoaneurysm is a rare condition commonly arises as a sequelae of pancreatitis. Pseudoaneurysm is clinically silent until it ruptures. Thus, untreated pseudoaneurysm carries a high mortality rate up to 90%. We present a case of necrotising pancreatitis complicated with unruptured splenic artery pseudoaneurysm, which was found incidentally from computed tomography (CT) of abdomen. Patient was presented with symptomatic anemia and bleeding from the abdominal drain. We proceeded with embolization of pseudoaneurysm by using Histoacryl glue, resulting in successful complete resolution of pseudoaneurysm with good patient outcome. Transcatheter embolization is considered the current treatment of choice for pseudoaneurysm as it provides an alternative to conventional surgery due to its high successful rate. In this case report, we want to shed light on an alternative treatment approach of the splenic artery pseudoaneurysm.
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Pseudoaneurysm is a well-documented but rare complication of retrograde femoral arterial puncture. We present six patients in whom pseudoaneurysm complicated this procedure. The pseudoaneurysm arose from the superficial femoral artery in five patients and from the profunda femoris artery in one. An arteriovenous fistula also arose from the superficial femoral artery in one patient. In no patient did the pseudoaneurysm arise from the common femoral artery. Two mechanisms are postulated as to why pseudoaneurysms rarely complicate puncture of the common femoral artery.
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Superficial femoral artery
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To improve the diagnosis and treatment of iaotrogenic pseudoaneurysm, 22 cases of iaotrogenic pseudoaneurysm were evaluated.There were 19 men and 3 women, aged from 20 to 78 years(average 43.6 years). The clinical courses ranged from 7 hours to 13 months with an average duration of 4.7 months. 16 elective, and 3 emergency operations were performed.19 cases were treated successfully, and one who had had compression repair failed received operative treatment.Iaotrogenic injury is the main cause of traumatic pseudoaneurysm, and can be prevented. Its treatment should accord to individual cases. Compression repair can be considered the first step for the management of postcatheterization pseudoaneurysms.
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Summary Ultrasound-guided compression repair of a pseudoaneurysm is a simple, safe and effective therapy, and has been proposed as a first-line treatment for pseudoaneurysms caused by catheterization. Herein, we report a case of a pseudoaneurysm arising from a sport injury which was treated by this method. Obliteration of the track of the pseudoaneurysm induced manual thrombosis and successfully converted the pseudoaneurysm to haematoma. Understanding the mechanism and the procedure is the basis of success in the use of this treatment.
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Comparative study on the etiology and the radiographic findings of corrosive esophagitis in children
Objective To investigate the relationship between the corrosive and the degree of injured esophagus by analyzing the X-ray findings of corrosive esophagitis(CE) in children. Methods Sixteen cases of CE were reported. There were 14 males and 2 females and the age ranged from 1 to 11 years withe the average of 3.4 years. The aera and degree of the injured esophagus were analyzed respectively according to the characteristic and dose of the corrosive and the X-ray findings. Results The average length of esophageal stricture in 16 cases was 10.7 cm,which was 63.4 percent of the whole esophagus. The width of stricture was 0.1～1.2 cm. The injury occurred in the middle and terminal esophagus in 13 cases (83.1%). The average percentages of the esophageal stricture caused by lyes and acids were 70.5% and 42.0%,respectively. The difference of the two groups was statistically significant (t=2.359, P0.05). Conclusion Serious and extensive stricture of the CE in children often occurs in the middle and terminal esophagus.The severity of lesions depends on the type, quantity, and concentration of the caustic substance ingested,as well as on the time of contact with the mucosa. The esophageal length of injury caused by lyes is more extensive than that caused by acids.
Esophageal stricture
Esophagitis
Etiology
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Pseudoaneurysm is a rare but potentially fatal complication in chronic pancreatitis. The proposed mechanisms for the formation of the pseudoaneurysm suggested the prevalence of pancreatic enzymes at the peripancreatic region or within the pseudocyst that causes erosion of the adjacent arterial wall, leading to vessel rupture into the surrounding cavity or the pseudocyst sac. Mortality rates for pseudoaneurysm rupture can be as high as 70% depending on the condition of the patient, additional comorbidities, the location of the pseudoaneurysm, and the treatment received. The incidence rate for jejunal artery pseudoaneurysm, whether with or without association to chronic pancreatitis, is exceptionally infrequent, with only a handful of cases ever reported. We present a rare case of a 37-yearold patient with a gigantic (10.3 cm in maximum diameter) pseudoaneurysm arising from the 1st jejunal artery with active contrast extravasation into the pseudoaneurysm sac observed under computed tomography angiography. Given the rarity of jejunal pseudoaneurysms, this is the largest size ever reported in current literature. We propose the noteworthy size is linked with continual irritation from surrounding chronic pancreatic inflammatory reactions, resulting in the increased elasticity and pliancy of the pseudoaneurysms/pseudocyst walls. This case report also offers an example of successful endovascular intervention for jejunal pseudoaneurysm in which surgical intervention is technically difficult or even impossible.
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Extravasation
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A 16-year-old male injured in his mouth by firework. 2 month later, esophageal stricture developed and esophageal dilatation using a dilater tube was performed every 2 weeks and 48 times in total. But esophageal dilatation could not be preserved. A flexible artificial esophagus is easy of insert and release, so we tried insertion of this artificial esophagus. 2 month later, we released this artificial esophagus from his esophagus. Since this treatment, his symptom has improved. Treatment of esophageal dilatation using a flexible artificial esophagus is useful for benign esophageal stricture because of easy of insert and release.
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Iatrogenic femoral artery pseudoaneurysm is a common complication of the endovascular procedures. Manual compression and thrombin injection are the conventional techniques to occlude the pseudoaneurysms. However, there are still some failed cases that applied these treatment options. The aim of the study is to seek a potential and alternative method with ProGlide system to close the pseudoaneurysm. During April 2018 to February 2019, 2 patients with iatrogenic pseudoaneurysm of the superficial femoral were treated with the suture-base closure device--ProGlide. After punctured the pseudoaneurysm and placed a 6-F sheath, the guide wire was placed in the right femoral artery via the access of the pseudoaneurysm neck. Then the pseudoaneurysm neck was sutured by ProGlide to occlude the blood supply to the pseudoaneurysm. These 2 patients were cured with no complications and complaints, which revealed that percutaneous suture technique with ProGlide at the neck level of pseudoaneurysm provides a novel method for the management of vascular access pseudoaneurysm, especially in those with a wide and short neck.
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Vascular closure device
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Pseudoaneurysm
Anticoagulant Therapy
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