Chulalongkorn Medical Journal


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


Faculty of Medicine, Chulalongkorn University

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