[Aortoesophageal fistula 19 years post-chemoradiotherapy for advanced esophageal cancer:a case report].

This case report describes an 84-year-old female who developed a fatal aortoesophageal fistula (AEF) 19 years post-chemoradiotherapy (CRT) for advanced esophageal cancer (cT4N2M1b (HEP), and cStage IVB). The patient was treated with fluorouracil, cisplatin, and 50-Gy radiation and achieved complete remission with no recurrence. She remained under long-term follow-up. Two years before the fatal event, an esophageal ulcer was noted in the irradiated area during routine endoscopy;however, the biopsy showed no malignancy. The ulcer was managed with a proton pump inhibitor, and follow-up endoscopy confirmed healing. One year later, she collapsed at home due to massive hematemesis and was transported to the emergency department in hemorrhagic shock. Emergency endoscopy revealed findings highly suggestive of AEF. Despite attempts at balloon tamponade for hemostasis, she went into cardiac arrest and could not be resuscitated. An autopsy confirmed a 3-mm fistula between the esophagus and aorta at the post-radiotherapy site. Histopathology revealed chronic radiation-induced ulceration, vascular wall thickening, and severe capillary narrowing in the outer esophageal membrane. Giemsa staining revealed bacterial infiltration at the fistula site, suggesting that secondary suppurative aortitis was the cause of fistula formation. Notably, no residual or recurrent tumor was detected. AEF is a rare but catastrophic late complication of CRT for esophageal cancer and is often fatal.