Abstract
We report a case in which the use of a polytetrafluoroethylene (PTFE) pledget for suturing the brachiocephalic artery led to the formation of a mediastinal abscess 5 years after operation. The patient showed rupture of the brachiocephalic artery caused by inflammation due to anastomotic insufficiency after a previous esophagectomy.
The patient was a 71-year-old man who underwent esophagectomy for esophageal cancer, cervical anastomosis of the esophageal-gastric conduit, and triregional lymph node dissection. Pathological examination revealed the tolloving findings : tumor location, Lt ; tumor type, type 2 SCC ; and tumor stage, stage III pT3N2M0IM0. We recognized anastomotic insufficiency 11 days after the operation and brachiocephalic arterial rupture induced by an abscess 24 days after that. We performed stenotomy and closed the rupture of the brachiocephalic artery by using a pledget. However, the patient showed recurrent superior mediastinitis 5 and a half years later. Computed tomography (CT) showed a high-density area that was suspected to be the pledget in the superior mediastinal abscess. We were able to successfully extirpate the abscess, including the pledget, from the brachiocephalic artery without injury. Postoperative course was good. He was discharged 14 days after the operation. He showed no recurrence of the abscess and esophageal cancer for about 3 years after the last operation.
