Case Report: Aortoesophageal fistula after radical gastrectomy for cardia cancer: diagnostic problems and successful staged treatment.

An aortoesophageal fistula (AEF) following radical surgery for gastric cardia cancer is a rare and serious problem with a historically dismal prognosis. Diagnosing it was difficult because the patient did not show the typical set of symptoms and the initial digital subtraction angiography (DSA) failed to reveal the underlying pathology. Treatment involved a planned multi-specialty approach. First, emergency stent placement in the aorta (TEVAR) was performed to achieve hemostasis. Later, planned surgeries were performed including esophageal exclusion and then colonic interposition to rebuild the food passage. This combined method led to the patient surviving for over three years. This case underscores the necessity for clinicians to maintain a high index of suspicion for aorto-esophageal fistula (AEF), even when initial diagnostic evaluations are unremarkable. It also shows that TEVAR alone is often not enough and a carefully planned series of operations to control both bleeding and infection can lead to a favorable long-term outcomes.