Aortoesophageal fistula 19 years after radiotherapy for oesophageal cancer: a case report.

Background: Aortoesophageal fistula (AEF) is a life-threatening disease that causes massive bleeding, sepsis, and ultimately death. Therefore, emergency treatments are required. Recently, cases of AEF treated with thoracic endovascular aortic repair (TEVAR) have been reported. Case summary: An 84-year-old man was referred to a local hospital with massive haematemesis and transient loss of consciousness. The patient's medical history included radiotherapy for oesophageal cancer 19 years before presentation. Gastrofiberscopy revealed an ulcer in the thoracic oesophagus and no recurrence of oesophageal cancer. Computed tomography (CT) showed that the same area was adjacent to the thoracic aorta and that there was no thoracic aortic aneurysm. The patient was then transferred to our institution for surgical treatment. We diagnosed the patient with an AEF caused by radiotherapy of the oesophagus. Therefore, TEVAR was performed. Due to the patient's advanced age, condition, and the possibility of strong adhesions, there was a high risk that they would be unable to tolerate oesophagectomy to prevent stent graft infection. Therefore, antibiotic therapy was initiated. However, CT revealed a stent graft infection 24 days after TEVAR. The patient died of sepsis 27 days after the procedure. Discussion: We describe the first case of AEF as a very late complication of radiotherapy for oesophageal cancer. Surgery to repair oesophageal defects is necessary to prevent stent graft infection. However, the decision for such surgery should be made on a case-by-case basis, taking into account the patient's condition and ability to tolerate the procedure.