title: Esophageal perforation of aortic arch aneurysm treated free of mediastinitis without manipulating esophagus.
abstract: Esophageal perforations of thoracic aortic aneurysms are most likely to be fatal. Patients with aortoesophageal fistula require urgent operation on both the esophageal perforation site and the aortic lesion to avoid terminal exsanguination and uncontrollable mediastinitis. We present a case of 71-year-old woman suffering esophageal perforation of aortic arch aneurysm with sentinel arterial hemorrhage, who has not developed patent aortoesophageal fistula. Computed tomography verified rupture of aortic arch aneurysm that had eroded the esophagus. She underwent successful graft replacement and remains well without signs of mediastinitis over one year after the event. It is possible, in selected cases of esophageal perforation of thoracic aortic aneurysm, to manage the esophageal lesion without any surgical intervention, such as primary closure, omental coverage and surgical discontinuity to achieve esophageal healing free of infection.
authors.affiliation: Department of Cardiovascular Surgery, Saitama Municipal Hospital, Saitama, Japan.
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Cho
authors.forename: Satoru
authors.initials: S
authors.lastname: Suzuki
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Katogi
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Ueda
mesh_terms: D000368:Aged; D017545:Aortic Aneurysm, Thoracic / Q000150:complications* / Q000601:surgery*; D001019:Aortic Rupture / Q000150:complications* / Q000601:surgery*; D004939:Esophageal Perforation / Q000209:etiology*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006801:Humans; D008480:Mediastinitis / Q000209:etiology*; D016896:Treatment Outcome