Aorto-conduit fistula developing four years after esophagectomy

A practical approach to the post esophagectomy CT: expected postoperative anatomy and anatomical approach to associated complication

This pictorial review aims to provide a structured approach to the interpretation of post esophagectomy CT by reviewing the major esophagectomy surgeries and conduit reconstructions, along with their associated complications at key anatomical landmarks. This paper combines an image rich experience and evidence-based approach to common and rare complications. The paper begins with an overview of the conventional Ivor Lewis esophagectomy and the expected postoperative imaging appearance (with separate detailed tables on additional surgical reconstructions), followed by a focused review of various complications at specific anatomical sites in a systematic fashion. By the conclusion of this review, radiologists will be equipped to employ a systematic approach to post-esophagectomy CT interpretation, confidently identifying both common and uncommon complications.

Aortoesophageal Fistula Occurring Due to Aortic Aneurysm

Upper gastrointestinal bleeding is a rare presentation of the aortoesophageal fistula (AEF) and is usually caused by thoracic aortic aneurysms. We present the case of a 61-year-old male who presented with chest pain and hematemesis. A chest X-ray showed a widened mediastinum. The patient underwent computed tomography angiography (CTA), which showed the presence of a large aneurysm in the aorta, which caused compression of the trachea, esophagus, and left pulmonary artery. Additionally, there was evidence of an AEF. It was decided to perform an emergency surgical intervention on the patient. However, the patient had multiple episodes of hematemesis and expired.

Successful management of an aorto-gastric fistula occurring 15 years after oesophagectomy with covered aortic stent graft placement followed by open surgery

Aorto-gastric fistula (AGF) is an uncommon and life threatening complication of oesophagectomy. Usually occurring in the immediate weeks following the procedure at anastomosis lines, this case describes a rare development of an AGF 15 years after an oesophagectomy due to the presence of a benign ulcer. Initially successful endovascular stenting of the thoracic aorta was followed by re-bleed, further stenting but eventually open surgery was required.