Chulalongkorn Medical Journal


Esophageal necrosis is a rare complication of treatment of the descending thoracic or thoraco-abdominal aortic aneurysm. It is almost always fatal. Sepsis and bleeding secondary to dehiscence of the aortic- graft suture line are main mechanisms of death. However, these patients can be saved by aggressive medical and surgical treatment. A 40-year-old male was transferred to this hospital because of severe epigastric pain secondary to concealed rupture of a descending aortic aneurysm. Urgent aneurysmectomy and bypass graft was done using "clamp-and-go technique". He was in septic conditions approximately a week later. An abscess around the graft was confirmed by CT scan. The second operation was taken; the findings were necrosis of the lower esophagus with heavy contamination around the graft. The contaminations were removed as much as possible by saline irrigation and some suspicious aortic aneurysmal wall was resected then the graft was covered with pedical omental flap. Also, esophagectomy, gastrostomy, and feeding jejunostomy were done. Intravenous antibiotics were continued. His septic conditions seemed to be improved. Three weeks later, he became febrile due to remaining collections surrounding the graft. The third operation was taken in order to do another aggressive debridement and irrigation. Finally, he had no more the aortic infection and was discharged. Duration of all the mentioned treatments was approximately 5 months. A month later, reconstruction of the esophagus with colon was done in the fourth operation as the patient requested. Minimal complications occurred and were treated during this period. He was discharged home in approximately a month. Six months later at the follow-up encounter, he reported that he could eat regular diet and was full-time job. The total period of all the treatments including recoveries to have normal livings was approximately 1 year.



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