Successful treatment of primary aorta-esophageal fistula resulting from aortic aneurysm.

Most aneurysms of the descending thoracic aorta rupture unless treated surgically. Autopsy studies in these patients indicate that rupture occurs into the esophagus in 10% of the cases and constitutes the most common cause of aorta-esophageal fistula. A reasonable literature review has not revealed a previously successful treatment for this condition. Experience in the treatment of patients with aneurysms of the descending thoracic aorta partially obstructing the esophagus without fistula formation indicates that simple graft replacement is curative. When the disease has progressed to actual fistula formation and esophageal bleeding, as illustrated in these two case reports, operation is done to prevent exsanguination. Appropriate management involves control of hemorrhage and treatment of the chronic esophageal perforation. The former is accomplished by resection and graft replacement of the ruptured thoracic aneurysm. Alternatives in dealing with the chronic esophageal defect are planned, staged reconstruction in high-risk patients and immediate resection and intrathoracic esophagogastrostomy in selected patients.