[A 16-year-old patient with dysphagia].
A 16-year-old man with an 8-year history of progressive dysphagia was referred to hospital. There was no specific finding in his family history. Physical examination was unremarkable. Complete blood count, serum electrolytes, and liver and kidney function tests were normal. Barium swallow revealed an extrinsic impression of the upper esophagus posteriorly. Magnetic resonance angiography demonstrated an aberrant origin of the right subclavian artery, leaving the aorta below the left subclavian artery. The artery had a retroesophageal course, causing the esophageal narrowing. Due to the persistence and worsening of the patient's symptoms, resection and reconstructive bypass surgery were recommended. Surgical correction was performed through a combined right supraclavicular incision and left posterolateral thoracotomy. After application of a vascular clamp, the aberrant right subclavian artery was ligated almost at its origin, and an end-to-side anastomosis was made with the right common carotid artery. At the end of the operative procedure, good pulses were palpated in the right radial artery. Postoperatively, the patient tolerated a regular diet without symptoms of dysphagia and was discharged on postoperative day 7.
Brueck
M
M
Medizinische Klinik I, Klinikum Wetzlar, Akademisches Lehrkrankenhaus der Justus-Liebig-Universität Giessen, Forsthausstrasse 1, 35578, Wetzlar. Martin.Brueck@hkw.med.uni-giessen.de
Bandorski
D
D
Rauber
K
K
Heidt
M
M
Vogt
P
P
Kramer
W
W
D000293:Adolescent; D003680:Deglutition Disorders / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control*; D004940:Esophageal Stenosis / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008297:Male; D013348:Subclavian Artery / Q000002:abnormalities* / Q000601:surgery*; D016896:Treatment Outcome