Aortoesophageal fistula following Polyflex stent placement for refractory benign esophageal stricture.

Barrett’s esophagus, spinal kyphosis, and Hodgkin’s lymphoma, who had been treated with mediastinal radiation 25 years before, presented with a radiation− induced, refractory benign esophageal stricture that had shown only a limited response to monthly balloon dilations. Endoscopy identified an esophageal stric− ture extending from 21 cm to 23 cm. After controlled radial expansion balloon dila− tion, a 16 mm ” 9 cm, removable, self−ex− panding plastic stent (Polyflex; Boston Scientific, Natick, Massachusetts, USA) was deployed across the stricture. Her dysphagia resolved and the stent was re− moved 2 months later (l" Fig. 1). Two weeks later she presented with symptomatic stricture recurrence (l" Fig. 2). An 18 mm ” 9 cm Polyflex stent was placed, again with resolution of the dysphagia, and endoscopy at 6 months and at 8 months revealed the stent to be well positioned, without any evidence of tissue hyperplasia (l" Fig. 1). At 11 months, she presented with hematemesis and hypotension. Endoscopy identified massive bleeding at the proximal stent margin, and computed tomography re− vealed signs suggestive of esophageal perforation (l" Fig. 3). The patient died after an emergency thoracotomy, which had revealed erosion of the stent through the esophageal wall into the posterior surface of the aortic arch, with surround− ing inflammation and adhesions. Aortoesophageal fistula following Polyflex stent placement for refractory benign esophageal stricture