Ischemic esophageal necrosis secondary to traumatic aortic transection.
Esophageal necrosis with perforation secondary to traumatic aortic transection is extremely rare but usually fatal. A 47-year-old man complained of sudden swallowing difficulty 6 days after blunt trauma. Computed tomography showed a ruptured aorta and the midesophagus shifted to the right side with luminal obliteration because of the ruptured aorta. After primary repair of the partially transected aorta, unexpected mediastinitis because of esophageal perforation was noted. Upper endoscopy showed midesophageal ulceration, necrosis, and perforation. Biopsy samples were consistent with ischemia. The possibility of direct esophageal trauma or intraoperative esophageal injury was ruled out. Esophageal exclusion with thoracoscopic decortication and multiple antibiotics were ineffective, and the patient eventually died. Ischemic esophageal necrosis caused by mechanical compression can occur in a traumatic aortic transection. Dysphagia, when present with radiologic signs, indicates a displaced and compressed esophagus. In spite of aggressive surgical and medical treatment for a perforated esophagus, the prognosis remains poor.
Park
Nam-Hee
NH
Department of Thoracic and Cardiovascular Surgery, Keimyung University, Dongsan Medical Center, Daegu, South Korea.
Kim
Jae-Hyun
JH
Choi
Dae-Yung
DY
Choi
Sae-Young
SY
Park
Chang-Kwon
CK
Lee
Kwang-Sook
KS
Han
Seong-Wook
SW
Yoo
Young-Sun
YS
D001011:Aorta / Q000293:injuries*; D001019:Aortic Rupture / Q000150:complications*; D003680:Deglutition Disorders / Q000209:etiology; D004939:Esophageal Perforation / Q000150:complications / Q000000981:diagnostic imaging; D004947:Esophagus / Q000000981:diagnostic imaging / Q000473:pathology*; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D008480:Mediastinitis / Q000209:etiology; D008875:Middle Aged; D009336:Necrosis / Q000209:etiology; D011859:Radiography; D014949:Wounds, Nonpenetrating / Q000150:complications*