A multidisciplinary, staged, and minimally invasive surgical approach for aortoesophageal fistula caused by ingested fish bone: a case report

Abstract

Aortoesophageal fistula (AEF) caused by an esophageal foreign body (EFB) is a life-threatening condition with extremely high mortality. There is no consensus on optimal management. This report illustrates a multidisciplinary, staged, and minimally invasive strategy that may improve outcomes in EFB-induced AEF. A 70-year-old male presented with hematemesis 5 h after intermittent chest discomfort over two weeks following fish bone ingestion. Diagnosis was confirmed by chest CT, esophagogastroduodenoscopy, and aortography. Emergency thoracic endovascular aortic repair (TEVAR) was performed to control bleeding. This was followed by a combined thoracoscopic-laparoscopic procedure to resect the affected esophagus, debride the mediastinum, wrap the aortic fistula with omentum, and reconstruct the digestive tract. The patient recovered well and has remained alive and well with no recurrent symptoms during 10 months of follow-up. This case demonstrates the efficacy of a staged approach integrating endovascular and minimally invasive surgical techniques. TEVAR provides immediate hemorrhage control as a bridge, while subsequent thoracoscopic-laparoscopic surgery addresses esophageal injury and prevents graft infection through omental wrapping. The strategy may reduce the high mortality associated with traditional open repair, particularly in elderly patients with comorbidities. A multidisciplinary, staged, and minimally invasive approach combining TEVAR with thoracoscopic-laparoscopic esophageal resection and reconstruction may be a feasible treatment option for selected patients with EFB-induced AEF. Larger studies and longer follow-up are needed to validate its safety and durability.