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Войти в исследования Frontiers in medicine · 2025
Squamous cell carcinoma-induced gastric conduit-thoracic aorta fistula presenting with massive hematemesis 4 years after radical esophagectomy: a CARE guidelines-compliant case report.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
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Song Conghua, Peng Jianyang, Xu Huiyuan, Li Xiaomei
Аннотация
INTRODUCTION: Gastric squamous cell carcinoma (GSCC) arising within a gastric conduit is an exceedingly rare phenomenon, and its presentation as a gastro-aortic fistula has never been documented. This case highlights the diagnostic challenges and life-threatening potential of delayed aortoenteric complications after esophagectomy, and underscores the evolving role of endovascular therapy in emergent hemorrhage control.
PATIENT CONCERNS AND CLINICAL FINDINGS: A 75-year-old male presented with 6 h of recurrent, high-volume hematemesis and presyncope. On arrival, he was hypotensive (74/50 mmHg), tachycardic, and profoundly anemic (hemoglobin 64 g/L). Physical examination revealed marked conjunctival pallor but a soft, non-tender abdomen without signs of portal hypertension.
DIAGNOSIS INTERVENTIONS AND OUTCOMES: Emergent computed tomography angiography demonstrated contrast extravasation from the posterior wall of the gastric conduit into the descending thoracic aorta. Digital subtraction angiography confirmed a focal gastro-aortic fistula at the T6 level. Under angiographic guidance, thoracic endovascular aortic repair (TEVAR) was performed using a COOK ZTEG-2PT-30-200 covered stent graft, achieving immediate hemostasis. The patient received massive transfusion support (22 units packed red cells, 8 units cryoprecipitate, 2,000 ml fresh frozen plasma) alongside proton pump inhibitors and somatostatin. Two days post-repair, endoscopic biopsy of the conduit ulcer edge confirmed squamous cell carcinoma. The patient recovered without further bleeding and was discharged day 10 in stable condition. A multidisciplinary tumor board recommended adjuvant chemoradiotherapy. The patient and family opted for palliative care following oncologic consultation due to the advanced disease stage and overall clinical context.
CONCLUSION: In late post-esophagectomy patients presenting with massive upper gastrointestinal bleeding, high clinical suspicion for arterioenteric fistula is warranted. Computed tomography angiography and DSA should precede endoscopy in hemodynamically unstable patients. TEVAR offers a minimally invasive, rapid means of hemorrhage control, serving as a critical bridge to definitive cancer management.
PATIENT CONCERNS AND CLINICAL FINDINGS: A 75-year-old male presented with 6 h of recurrent, high-volume hematemesis and presyncope. On arrival, he was hypotensive (74/50 mmHg), tachycardic, and profoundly anemic (hemoglobin 64 g/L). Physical examination revealed marked conjunctival pallor but a soft, non-tender abdomen without signs of portal hypertension.
DIAGNOSIS INTERVENTIONS AND OUTCOMES: Emergent computed tomography angiography demonstrated contrast extravasation from the posterior wall of the gastric conduit into the descending thoracic aorta. Digital subtraction angiography confirmed a focal gastro-aortic fistula at the T6 level. Under angiographic guidance, thoracic endovascular aortic repair (TEVAR) was performed using a COOK ZTEG-2PT-30-200 covered stent graft, achieving immediate hemostasis. The patient received massive transfusion support (22 units packed red cells, 8 units cryoprecipitate, 2,000 ml fresh frozen plasma) alongside proton pump inhibitors and somatostatin. Two days post-repair, endoscopic biopsy of the conduit ulcer edge confirmed squamous cell carcinoma. The patient recovered without further bleeding and was discharged day 10 in stable condition. A multidisciplinary tumor board recommended adjuvant chemoradiotherapy. The patient and family opted for palliative care following oncologic consultation due to the advanced disease stage and overall clinical context.
CONCLUSION: In late post-esophagectomy patients presenting with massive upper gastrointestinal bleeding, high clinical suspicion for arterioenteric fistula is warranted. Computed tomography angiography and DSA should precede endoscopy in hemodynamically unstable patients. TEVAR offers a minimally invasive, rapid means of hemorrhage control, serving as a critical bridge to definitive cancer management.