title: One-stage operation for esophageal perforation of a thoracic aortic aneurysm.
abstract: The patient was a 65-year-old man. Preoperative computed tomography showed a ruptured thoracic aortic aneurysm that formed a submucosal hematoma in the thoracic esophagus with perforation near the esophageal-cardiac junction. A one-stage operation was performed. The aortic arch and proximal descending aorta were replaced with rifampicin-soaked synthetic grafts, followed by subtotal esophagectomy with primary reconstruction using a gastric tube. His early postoperative course was uneventful, and he started oral intake on postoperative day (POD) 15; however, dysphagia occurred on POD 20, and an esophageal fistula and mediastinitis developed more than 1 month after the operation. The patient recovered from mediastinitis after 4 months of mediastinal drainage and administration of antibiotics. Thus, a one-stage operation for esophageal perforation of a ruptured thoracic aortic aneurysm with primary esophageal reconstruction is possible in selected patients. Care must be taken to avoid postoperative compression of the reconstructed esophagus by a mediastinal hematoma.
authors.affiliation: Department of Cardiovascular Surgery, Kyushu Koseinenkin Hospital, Kitakyushu, Japan. imoto@m3.kufm.kagoshima-u.ac.jp
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Imoto
authors.forename: Akira
authors.initials: A
authors.lastname: Sese
authors.forename: Masato
authors.initials: M
authors.lastname: Sakamoto
authors.forename: Yoshie
authors.initials: Y
authors.lastname: Ochiai
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Noshiro
authors.forename: Akihiko
authors.initials: A
authors.lastname: Uchiyama
mesh_terms: D000368:Aged; D017545:Aortic Aneurysm, Thoracic / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D001019:Aortic Rupture / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D003680:Deglutition Disorders / Q000209:etiology; D004937:Esophageal Fistula / Q000209:etiology; D004939:Esophageal Perforation / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects; D006801:Humans; D008297:Male; D008480:Mediastinitis / Q000209:etiology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome