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A date pit induced aorto-oesophageal fistula: a case report and concise literature review
Kevin M Lichtenstein1, Thomas B Russell2, Julia B Lichtenstein3
1Department of Cardiac Surgery, Mazankowski Heart Institute, Edmonton, Alberta, Canada.
Insights
Aorto-oesophageal fistula (AEF) is a rare and fatal condition. This case highlights the critical
Area of Science:
- Cardiology
- Gastroenterology
- Thoracic Surgery
Background:
- Aorto-oesophageal fistula (AEF) is a rare but life-threatening condition.
- It often presents with a characteristic triad of symptoms following an asymptomatic interval.
Observation:
- A patient presented with chest pain, gastrointestinal hemorrhage, and exsanguination after ingesting a date pit.
- The 'Chiari' triad was observed, indicating a potential AEF.
Findings:
- The patient received initial management with a Blakemore tube.
- Despite planning for an aortic stent graft, the patient demised on the operating table.
- This case underscores the challenges in managing AEF.
Implications:
- Both open and endovascular surgical repairs are options for AEF treatment.
- Endovascular repair offers potential survival benefits but carries risks like infection and recurrence.
- Further research is needed to optimize AEF management strategies.
Abstract:
Aorto-oesophageal fistula (AEF) is rare and fatal without intervention. Having consumed a date pit 2 weeks prior, the patient in this case presented with the 'Chiari' triad of chest pain, sentinel arterial upper gastro-intestinal haemorrhage and exsanguination after an asymptomatic interval. Following resuscitation, the patient was managed with a Blakemore tube with both oesophageal and gastric balloons inflated to systemic pressures. An aortic stent graft was planned but the patient died on the operating table. AEFs can be treated surgically with either open or endovascular repair. Open repair is highly risky and involves combined replacement/bypass of the thoracic aorta along with resection/repair of the involved oesophagus. Endovascular repair can prevent fatal exsanguination and increase the likelihood of survival but is associated with a significant rate of secondary infection, recurrence of fistula, mediastinitis and sepsis. Further studies are required to inform on management.
