Aortoesophageal Fistula Rare and Challenging Complication Following Sleeve Gastrectomy

Hassan Al-Thani, MD, FACS; Yasir A. Al-Zubaidi, MD, FRCSI; Talat S. Chughtai, MD, FRCSC; Abdulwahid Al Mulla, MD; Ayman El-Menyar, MD

Product Details
Product ID: ACS-5483
Year Produced: 2018
Length: 12 min.


Aortoesoaphageal fistula is a rare but life-threatening cause of massive gastrointestinal bleeding without surgical intervention mortality rate is 100%. A 37 year old female, day ten post sleeve gastrectomy, presented to ED with abdominal pain, nausea, fever and leukocytosis. Abdominal CT scan showed three collections with air fluid level in the left upper quadrant. A CT guided percutaneous drain performed followed by upper GI contrast study and showing a contrast leak into a cavity. Gastroduodenoscopy performed and esophageal covered stent size 120 mm length deployed in the distal esophagus. The patient recovered slowly and the gastrographin study showed no leak, the stent was removed and the patient was discharged home. After 6 weeks, presented with massive GI bleeding required endoscopy, which failed to localize the source. A CT angio showed a contrast leak from the level of distal descending thoracic aorta into the esophagus. A failed attempt of angio embolization followed by successful endovascular aortic stenting. Ten moths later presented with upper GI bleeding and severe septic shock. CT scan and endoscopy showed an intra luminal discontinuity of the aortic and esophageal wall. The graft was exposed into lower part of esophagus. A multi disciplinary team involved in the surgical procedure for a thoraco-abdominal approach, a left heart bypass, removal of the infected stent and reconstruction of the thoracic aorta with a bovine pericardium tube graft and total esophagectomy and gastrostomy and jujenostomy tube. Conclusion: aortoesophageal fistula rare and challenging complication following sleeve gastrectomy .