Three‐stage approach for aortoesophageal fistula after Roux‐en‐Y esophagojejunostomy

Abstract

Surgical management of post‐esophagojejunostomy aortoesophageal fistula (AEF) has been scarcely reported, but is universally fatal. This report described a case of AEF after total gastrectomy with Roux‐en‐Y esophagojejunostomy and adjuvant chemoradiotherapy for gastric cardiac cancer. A three‐stage hybrid approach was used to successfully manage this complication. First, thoracic endovascular aortic repair curbed bleeding. Second, radical fistula resection eradicated infected areas and adjacent structures. Third, esophageal reconstruction using an ileocolonic conduit restored gastrointestinal continuity. This strategy could be safely feasible for managing post‐esophagojejunostomy AEF.

Abstract

This report described a case of aortoesophageal fistula (AEF) after total gastrectomy with Roux‐en‐Y esophagojejunostomy and adjuvant chemoradiotherapy for gastric cardiac cancer. A three‐stage hybrid‐approach was used to successfully manage this complication, as follows: (1) bridging thoracic endovascular aortic repair controls bleeding and stabilizes hemodynamics; (2) radical fistula resection eradicates infectious source and fragile structures; (3) esophageal reconstruction using an ileo‐colon conduit restores gastrointestinal continuity. This strategy could be safe and feasible for managing post‐esophagojejunostomy AEF.