Achieving Hemostasis With a Foley Catheter for Hemorrhagic Shock Caused by an Aortoesophageal Fistula of an Infected Thoracic Aortic Aneurysm With Dissection: A Case Report

Aortoesophageal fistulas (AEFs) are a rare complication of thoracic aortic aneurysms. Moreover, the associated massive bleeding from the upper gastrointestinal tract results in a very high mortality rate. In this report, we describe a successful experience in using a Foley catheter to save a patient's life. A 46-year-old man was admitted for an infected thoracic aortic aneurysm with dissection. Seven days after admission, emergency thoracic aortic stent graft insertion was performed due to esophageal perforation of the thoracic aortic aneurysm. Three hours after starting surgery, a diagnosis of continuous fresh blood hematemesis and an acute exacerbation of an AEF associated with an infected thoracic aortic aneurysm was established. The patient's blood pressure was no longer maintained due to massive bleeding. We temporarily placed a Foley catheter in the middle esophagus. Hemostasis with a Foley catheter was temporary and stopped the bleeding out of the body. The patient required intensive care to control the bleeding into the left thoracic cavity, and veno-venous extracorporeal membrane oxygenation had to be instituted for the worsening oxygenation. Increased intra-esophageal pressure due to balloon tamponade was considered a possible postoperative complication. The patient faced several complications and challenges during the intraoperative management, but a prompt response to these complications and challenges saved the patient's life. The efficacy of a Foley catheter in rapidly and effectively responding to active bleeding in critical settings was reaffirmed as a crucial aspect of life-saving procedures.