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Aortoesophageal fistula.

R Carter, G A Mulder, E N Snyder

    American Journal of Surgery
    |July 1, 1978
    PubMed
    Summary

    Aortoesophageal fistula, once rare, is now treatable thanks to cardiovascular surgery. Early recognition of Chiari's triad is key for timely intervention and patient salvage.

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    Area of Science:

    • Cardiovascular Surgery
    • Gastroenterology
    • Thoracic Surgery

    Background:

    • Aortoesophageal fistula (AEF) has evolved from a rare condition to a treatable diagnosis.
    • Advancements in cardiovascular and bypass procedures have improved AEF management.
    • Understanding the clinical presentation is crucial for effective treatment.

    Purpose of the Study:

    • To review the clinical presentation and diagnostic challenges of aortoesophageal fistula.
    • To discuss the impact of modern surgical techniques on AEF outcomes.
    • To highlight the importance of prompt surgical intervention in managing AEF.

    Main Methods:

    • Review of clinical cases presenting with aortoesophageal fistula.
    • Analysis of diagnostic modalities including contrast esophagography, esophagoscopy, and aortography.
    • Evaluation of surgical repair techniques for aortic and esophageal defects.

    Main Results:

    • Chiari's triad (midthoracic pain, sentinel hemorrhage, symptom-free interval, fatal exsanguination) remains a critical diagnostic clue.
    • Immediate left thoracotomy may be necessary for diagnosis and treatment in cases of profuse hemorrhage.
    • Approximately 80% of patients experience a symptom-free interval between sentinel hemorrhage and fatal exsanguination, offering a window for intervention.

    Conclusions:

    • Aortoesophageal fistula is a treatable condition with improved outcomes due to advances in cardiovascular surgery.
    • Prompt diagnosis, often requiring emergent thoracotomy, and surgical repair are essential for patient survival.
    • Surgeons trained in cardiovascular techniques are vital for salvaging patients with aortoesophageal fistula.

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