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Atrioesophageal Fistula is a rare complication after radiofrequency catheter ablation. In this article, we report a case of atrioesophageal fistula, confirmed by a Chest computed tomography scan and treated by two-stage surgical repair. In addition, we review the case reports about atrioesophageal Fistula in PubMed, with the aim of presenting here our experience and sharing our surgical approach. The methods of treatment and prevention of such complication are also reviewed in this article.

Oesophageal duplication cysts are a subtype of foregut cysts, associated with the presence of ectopic gastric mucosa. Gastric acid secreted by this mucosa can lead to complications. We report one such unusual case of complication leading to the formation of broncho-oesophageal fistula in a duplication cyst. A girl in her middle childhood presented with a long-duration cough and multiple respiratory infections. On investigation, a right-sided paraoesophageal air-filled cystic lesion was identified, with a possible communication with the airway, confirmed by an oral contrast study. On further workup, a positive uptake was noted on Meckel’s scan, signifying the presence of ectopic gastric mucosa. The findings were confirmed surgically and on histopathology and were consistent with a duplication cyst with broncho-oesophageal fistula. An unexplained upper respiratory tract symptomatology should mandate imaging, which would enable early detection and appropriate surgical management of such cysts in infancy and childhood.

Secondary aorto-oesophageal fistulas after thoracic endovascular aortic repair are a severe complication associated with high mortality rates. We present a case of staged oesophageal decompression performed via thoracoscopic resection of a residual aneurysm following thoracic endovascular aortic repair to prevent secondary aorto-oesophageal fistulas in a patient with a distal arch aneurysm causing significant oesophageal compression. A 70-year-old woman with a 3-month history of hoarseness was referred to our hospital. Computed tomography revealed a penetrating ulcer in the aortic arch, complicated by a 60 mm pseudoaneurysm causing significant oesophageal compression. Owing to multiple comorbidities, the patient had high perioperative risk, rendering total arch replacement unfeasible; therefore, endovascular repair was selected. After Zone 1 hybrid thoracic endovascular aortic repair, complete thrombosis of the aneurysm was confirmed. Staged residual aneurysm resection was performed via thoracoscopy through a small left thoracotomy relieve oesophageal compression. Two years postoperatively, computed tomography revealed aneurysmal reduction, complete resolution of the oesophageal pressure drainage and no evidence of secondary aorto-oesophageal fistula or stent graft infection.

A 50-year-old man with recently diagnosed lung cancer presented with shortness of breath and a cough. Water-soluble contrast esophagography (shown in a video) revealed a bronchoesophageal fistula.

Background Esophageal fistula (EF), a rare and potentially fatal complication, can be better managed with predictive models for personalized treatment plans in esophageal cancers. We aim to develop a clinical-deep learning radiomics model for effectively predicting the occurrence of EF. Methods The study involved esophageal cancer patients undergoing radiotherapy or chemoradiotherapy. Arterial phase enhanced CT images were used to extract handcrafted and deep learning radiomic features. Along with clinical information, a 3-step feature selection method (statistical tests, Least Absolute Shrinkage and Selection Operator, and Recursive Feature Elimination) was used to identify five feature sets in training cohort for constructing random forest EF prediction models. Model performance was compared and validated in both retrospective and prospective test cohorts. Results One hundred seventy five patients (122 in training and 53 in test cohort)were retrospectively collected from April 2018 to June 2022. An additional 27 patients were enrolled as a prospective test cohort from June 2022 to December 2023. Post-selection in the training cohort, five feature sets were used for model construction: clinical, handcrafted radiomic, deep learning radiomic, clinical-handcrafted radiomic, and clinical-deep learning radiomic. The clinical-deep learning radiomic model excelled with AUC of 0.89 (95% Confidence Interval: 0.83–0.95) in the training cohort, 0.81 (0.65–0.94) in the test cohort, and 0.85 (0.71–0.97) in the prospective test cohort. Brier-score and calibration curve analyses validated its predictive ability. Conclusions The clinical-deep learning radiomic model can effectively predict EF in patients with advanced esophageal cancer undergoing radiotherapy or chemoradiotherapy.

Abstract Objectives Although rare, aorto-oesophageal fistula remains one of the most critical diseases in cardiovascular surgery. The lack of prospective studies or large case series leads to an absence of evidence-based therapeutic concepts. Methods We conducted a retrospective analysis of patients treated for aorto-oesophageal fistula between 2014 and 2023. Primary endpoints of analysis were 30-day mortality and median survival; subgroup analysis was performed for aetiology as well as treatment strategy. Additionally, a systematic search was conducted for all studies researching treatment of the disease, including ≥5 patients and published within the last 10 years. Results In the collective of 10 patients, 4 manifested as primary fistula, while in 6 patients the fistula occurred secondary to previous thoracic endovascular aortic repair. Median duration to manifestation post-TEVAR was 20.1 months (34.1). Initial treatment consisted of TEVAR or TEVAR-relining in 7 cases, followed by bovine open aortic replacement (n = 1) or partial bovine patch repair (n = 2) when viable. Treatment of the oesophagus consisted of primary suture (n = 1) or oesophagectomy (n = 5) with gastric pull-up or colon interposition. Overall 30-day mortality was 40%, and overall median survival was 7.5 months (12.8). Patients receiving surgical treatment of the oesophagus exhibited longer survival than patients who did not (12.8 months [4.7] vs 0.35 months [0.4]). Across the reviewed literature, the strongest effect on survival originates from surgical treatment of the oesophagus. Specific surgical strategies as well as patient characteristics vary widely. Conclusions We found TEVAR effective in stabilizing the initial haemorrhage. Short-interval oesophagectomy seems to improve survival and should be considered in most patients. Open aortic replacement with bovine pericardium is a viable option. Interventional treatment options alone do not appear to be sufficient. Aorto-oesophageal fistula (AEF) is an orphan condition with a communicating fistulation between the aorta and oesophagus, with 100% mortality if left untreated. Graphical abstract

Background Broncho-esophageal fistula (BEF) secondary to esophageal diverticulum is a rare clinical condition, which is often misdiagnosed for a long time. The aim of our study is to summarize and clarify the advantages of MSCT in diagnosing BEF secondary to esophageal diverticulum. Methods We retrospectively analyzed patients clinically diagnosed with BEF from January 2005 to January 2022 at Jilin University First Hospital. Only those patients with BEF secondary to esophageal diverticulum and complete clinical data met our enrolled standard. All patients’ clinicopathologic characteristics and MSCT features were systemically evaluated. Results 17 patients were eligible for our cohort study, including male 10 and female 7. The patient’s mean age was 42.3 ± 12.5. The chronic cough occurred in all seventeen patients and bucking following oral fluid intake was documented in nine patients. MSCT distinctly suggested the fistulous tract between the bronchi and the esophagus in all patients. The mean diameter of the orifices in the wall of the esophagus was 4.40 ± 1.81 mm. The orifice in the midthoracic esophagus side was 15 cases and 2 cases at the lower thoracic esophagus. The involved bronchus included 13 cases at the right lower lobe bronchus, 1 at the right middle lobe bronchus and 3 at the left lower lobe bronchus. The contrast agent was observed in the pulmonary parenchyma in 10 of 13 patients who underwent esophagogram. No definite fistula was observed in 3 of 11 who underwent gastroscopy, while the intra-operative findings supported the existence of fistula. Conclusions BEF secondary to esophageal diverticulum tends to occur between the midthoracic esophagus and the right lower lobe bronchus. Compared with esophagography and gastroscopy, MSCT shows more comprehensive information about the fistulous shape, size, course and lung involvement, which are helpful for establishing diagnosis and guiding subsequent treatment.

Esophageal diverticulum with secondary bronchoesophageal fistula is a rare clinical entity that manifests as respiratory infections, coughing during eating or drinking, hemoptysis, and sometimes fatal complications. In the present study, we describe a case of bronchoesophageal fistula emanating from esophageal diverticulum in a 45-year-old man who presented with bronchiectasis. We summarize the characteristics of this rare condition based on a review of the relevant literature.

Respiratory distress developed in a neonate after delivery at 32 weeks of gestation. Endotracheal intubation was unsuccessful, and he died 4 hours after delivery. A postmortem esophagram obtained after the administration of barium showed tracheal agenesis and bronchoesophageal fistula.