Management of Aortoesophageal Fistula in palliative patient with non-small-cell lung cancer: A case report.

INTRODUCTION: Aortoesophageal fistulas are a rare but life-threatening complication in patients with thoracic malignancies.

CASE PRESENTATION: We describe a case of a 55-year-old female patient with metastatic non-small-cell lung cancer (NSCLC). Due to esophageal tumor compression, a fully-covered self-expanding metal stent (fcSEMS) had been deployed in the esophagus several months before. The patient was subsequently admitted to the emergency department with massive hematemesis. Endoscopy suggested a fistula between the aorta and the esophagus proximal of the fcSEMS, which was confirmed by computed tomography (CT) and led to hemodynamical relevant upper gastrointestinal bleeding. A thoracic endovascular aortic repair was performed to stop the hemorrhage. After the successful intervention, the patient needed long-term antibiotic treatment and the fcSEMS remained in place. Afterwards, the patient continued palliative tumor therapy using Pembrolizumab for further five months. The patient died eight months after the initial admission to the emergency department.

CONCLUSION: This is to the best of our knowledge the first case of a technical successful interventional therapy of an aortoesophageal fistula which did not only achieve hemostasis but enabled the patient to continue tumor therapy to regain quality of life.