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Aortic penetration due to a fish bone: a case report.

Daming Jiang¹, Yi Lu², Yigong Zhang³

¹Department of Cardiovascular Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, 88 JieFang Road, Hangzhou, P.R. China, 310009. to_jiangdm@zju.edu.cn.

Journal of Cardiothoracic Surgery

|October 3, 2020

Summary

A rare case of aortoesophageal fistula (AEF) caused by a fish bone directly piercing the aorta is presented. Early diagnosis and intervention are crucial for managing this life-threatening condition.

Keywords:

Aortic infection Aortic penetration Aortoesophageal fistula Case report Esophageal foreign body Esophageal perforation Mediastinitis Surgery Thoracic endovascular aortic repair

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Area of Science:

Gastroenterology
Vascular Surgery
Emergency Medicine

Background:

Aortoesophageal fistula (AEF) is a rare but life-threatening condition often resulting from esophageal foreign bodies.
Direct aortic penetration by a foreign body is exceptionally uncommon, posing significant diagnostic and management challenges.
High mortality rates underscore the urgency of timely diagnosis and intervention in suspected AEF cases.

Observation:

A 31-year-old female presented with swallowing pain after consuming fish.
Gastroscope examination revealed an esophageal foreign body, later identified as a fish bone.
Computed tomography confirmed direct aortic penetration by the fish bone, establishing an aortoesophageal fistula.

Findings:

Surgical repair of both the aorta and esophagus was successfully performed.
The patient experienced an uneventful postoperative recovery and follow-up period.
This case highlights the potential for sharp foreign bodies to directly breach the aortic wall.

Implications:

Clinicians must maintain a high index of suspicion for AEF when patients present with esophageal foreign bodies, especially sharp ones.
Prompt diagnosis through imaging (e.g., CT) and early surgical intervention are critical for improving outcomes.
Long-term management and follow-up strategies for AEF require further development and standardization.