Aortoesophageal fistula with hemorrhagic shock successfully treated with resuscitative endovascular balloon occlusion of the aorta

Aortoesophageal fistula with hemorrhagic shock successfully treated with resuscitative endovascular balloon occlusion of the aorta

Hemorrhagic shock, Aortoenteric fistula, REBOA

Abstract
Background Aortoesophageal fistula (AEF) is a rare cause of upper gastrointestinal hemorrhage. Despite diagnostic
and therapeutic advances, the mortality rate in AEF patients remains high because of its fulminant course, even with
maximal intensive care. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a resuscitation technique
to control life-threatening bleeding. It has become an important modality in the management of life-threatening,
traumatic or non-traumatic, arterial bleeding. However, it’s use in hemorrhagic shock caused by cancer has rarely
been reported.
Case presentation A 51-year-old woman with a history of esophageal cancer presented to our emergency
department with hematemesis. Computed tomography was performed because of a strong suspicion of
hemorrhagic shock. With a diagnosis of AEF due to esophageal cancer, emergency thoracic endovascular aortic repair
was performed while the bleeding was controlled using REBOA. Staged elective esophageal reconstruction was
successfully performed.
Conclusions Hemostasis is crucial in patients who present with suspected hemorrhagic shock attributable to AEF.
The timely implementation of REBOA has shown promise and potential effectiveness in such cases.
Keywords Hemorrhagic shock, Aortoenteric fistula, REBOA

Tadayuki Hirai1*, Masaki Okajima1

, Toru Noda1

and Yoshikazu Goto1

https://doi.org/10.1186/s12245-024-00706-1

2024

Peri Irawan

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