[Aorto-oesophageal fistula due to an aortic endovascular prosthesis: case report and state of the art].

Aorto-oesophageal fistula is a rare and often fatal condition due to pathologies of the aorta and oesophagus. Recently, a new aetiology for aorto-oesophageal fistulas has been detected, namely, decubitus of an aortic endovascular prosthesis positioned in the presence of aneurysms. The symptoms are those of Chiari's triad: (1) chest pain and/or dysphagia (2) haematemesis (3) massive haematemesis. If the patient is haemodynamically stable the gold standard diagnostic examination is a CT scan with contrast medium. Aorto-oesophageal fistulas are characterised by a rapidly worsening acute clinical presentation and high postoperative morbidity and mortality. The treatment of aorto-oesophageal fistula is divided into three progressive steps: (1) control of bleeding; (2) prevention of mediastinitis; (3) oesophageal repair. We report a case of a 59-year-old male patient with an aorto-oesophageal fistula due to the decubitus of an endovascular aortic prosthesis previously positioned for a traumatic aneurysm of the descending aorta. We controlled the bleeding in emergency with a Sengstaken-Blakemore tube. Since the cardiovascular surgeons excluded any intervention, we executed a bipolar oesophageal exclusion in our department of general surgery and subsequently positioned a self-expanding oesophageal prosthesis by a retrograde route. The patient survived for 7 months, the cause of death being septic shock.