Abstract
A 58-year-old woman visited a neighboring hospital because of abdominal pain and vomiting in July of 2012. A blood analysis revealed increased inflammatory reaction and gastric endoscopy revealed esophagus narrowing which was caused by cxtramulal compression. Following an abdominal CT scan, posterior mediastinal hematoma from the descending aorta was observed. The patient was transferred to our hospital for close examination and treatment. By close exploration rupture of a pseudoaneurysm of the thoracic aorta was diagnosed and an emergency operation was performed. During surgery, an 8 mm sized perforation was identified at the descending aorta. After the resection of the perforated site with thrombus and abscess, we were able to visually confirm the perforated site to the esophagus. The intraoperative diagnosis was rupture of the infected aortic aneurysm and esophageal perforation, and synthetic graft replacement for the descending aorta and plication suture of the esophagus were performed. On the 9th postoperative day, suture failure of the esophageal plication site was diagnosed. Resection of the thoracic esophagus, cervical esophagestomy and creation of gastrostomy were performed. Following sustained lavage of the thoracic cavity after the reoperation, the patient was discharged from our hospital on the 51st postoperative day. She underwent anastomosis between the cervical esophagus and gastric tube via the ante-thoracic route 11 months after the initial operation, and has been followed in our out-patient clinic.
