Aortoesophageal fistula (AEF) is a relatively rare and usually fatal disease, with no established treatment at present.
We recently successfully treated a patient with esophagectomy and a latissimus dorsi muscle transfer for AEF following thoracic endovascular aortic repair (TEVAR).
In treating AEF, prevention of fatal bleeding and infection is important. To prevent fatal bleeding, TEVAR has recently gained recognition as an initial emergent treatment. In addition, prevention of continuous contamination through the fistula has utilized omental flap coverage, as reported in several papers.
However, an omental flap was not available for our patient, because he was scheduled for gastrectomy due to gastric cancer.
Therefore, we decided to use a latissimus dorsi muscle flap to cover the fistula, because it has a rich blood supply, sufficient length to reach the fistula, and adequate volume to cover the entire fistula.
The postoperative course was uneventful, and the patient was discharged about six months after being admitted.
Accordingly, we feel that a latissimus dorsi muscle transfer is useful for the treatment of AEF when an omental flap is unavailable because of laparotomy or gastrectomy.