Successful management of aorto-oesophageal fistula with dual oesophageal and aortic intervention

Figure 1: The patient underwent an emergency oesophageal endoscopy after swallowing a fish bone. At oesophagoscopy, a fish bone situated 25 cm from the incisors was removed uneventfully. Seven days later, she developed retrosternal pain and haematemesis. She vomited 200 ml of bright red blood. Bilateral oesophageal perforations with local fester were found 25 cm away from the incisors in oesophagoscopy examination. A diagnosis of aorto-oesophageal fistula was made. A removable oesophageal stent (long arrow (A)) was implanted to isolate the oesophageal perforation. Axial CT angiography revealed a rupture of the thoracic aorta (short arrow (A)) and numerous air bubbles and fluid collection around the thoracic aorta. Sagittal reconstruction (B) and volume rendering (C) of CT angiography showed an aortic pseudoaneurysm (arrow) at the anterior wall of the thoracic aorta.