Description
Clinical History
A woman who swallowed a chop bone during lunch collapsed later in the afternoon and suffered a massive hematemesis. At laparotomy, the stomach was filled with fresh blood but the cause was not identified. She died one day later and necropsy revealed a communication between aorta and oesophagus. The stomach was distended with blood and contained a few fragments of bone.
Pathology
The specimen is a block dissection of distal trachea (posterolateral on right margin), aortic arch (opened in coronal plane and viewed from anterior aspect) and oesophagus (posteriorly and opened longitudinally). The oesophageal mucosa is ulcerated and hemorrhagic. A small blue probe identifies a fistula between the oesophagus and posterior wall of the thoracic descending aorta.
Note
While this scenario was a traumatic cause of oesophageal-aortic fistula, it should be noted that there are non-traumatic causes of the same. In fact, these fistulae can be caused by compression of the aorta from an aneurysm, advanced gastrointestinal malignancies or erosion of an aortic graft into adjacent gastrointestinal tract and can occur anywhere along the length of the aorta.
Aorto-enteric fistulas are life-threatening. The most common presentation is gastrointestinal bleeding and can present as either minor bleeding or a large life-threatening bleed that results in hemodynamic compromise. Patients can present with melaena (dark sticky feces containing partly digested blood) or frank bleeding in stools. In smaller fistulas with slow, minor bleeds, patients can present with malaise or ischemia of lower limbs due to less blood flow from the aortic bleed. Other presentations include hematemesis as occurred in this case.
Diagnoses of these fistulas can be difficult, depending on the cause, size and location of the fistula. In a stable patient, endoscopic exploration or CT angiography may be first line options for diagnosis. However, diagnosis in hemodynamically unstable patients is more time critical and may require laparotomy as well stabilization with blood transfusions.
Advantages
- Anatomically accurate and identical to real specimen
- No ethical issues - not real human body parts
- Reasonably priced
- Available within a short lead time
- Reproducible, several identical prints can be used as a classroom set
- Can be produced in different sizes to cater for the needs of the teacher
Human Cadavers
- Access to cadavers can be problematic. Many countries cannot access cadavers for cultural and religious reasons
- Cadavers cost a lot money
- High cost for establishing your own plastination suite
- Wet specimens cannot be used in uncertified labs
- Dissection of cadavers is a lot of staff time and that is a cost
- Storage of cadaver material needs special refrigeration etc. which has coast
- If you want another specimen you have to start all over again
Plastinates
- Costs
- Ethical issues
- Timeframe for plastination process
- Many countries do not allow their importation
- One of a kind
Superior 3D print results compared with conventional methods
- Vibrant color offering with 10 million colors
- UV-curable inkjet printing
- High quality 3D printing that can create products that are delicate, extremely precise and incredibly realistic
Clear Support Material
- To avoid breakage of fragile, thin, and delicate arteries, veins or vessels, a clear support material is printed on such spots. This makes the models robust and can be handled by students easily.
