A Case of Aortoesophageal Fistula Treated by Aortic Graft with Omental Flap Transposition on Condition that Two-stage Esophageal Reconstruction was Followed

Abstract

A 69-year-old woman with previous history of undergoing ascending aortic replacement underwent esophagectomy with a two-stage reconstruction in addition to thoracoabdominal aortic replacement for an aortoesophageal fistula arisen in a descending aortic aneurysm at the inferior mediastinum. In the first-stage operation, we performed thoracoabdominal aortic replacement, subtotal esophagectomy, omental flap transposition, cervical esophagostomy and gastrostomy via thoraco-abdominal approach in the right half side-lying position via left thoracolaparotomy. To create an omental flap, the right gastroepiploic artery and vein was preserved on the stomach side for subsequent use to reconstruct a gastric tube ; and an omental flap with the left gastroepiploic artery and vein as a pedicle was pulled up in the thoracic cavity through the esophageal hiatus. In the second-stage operation, the left gastroepiploic artery and vein which was the pedicle of the omental flap was preserved along the gastric wall not to injure, the gastric tube was then mobilized and pulled up for reconstruction through the antethoracic route. After the operation she developed anastomotic failure that caused a slightly delayed recovery, but she could be discharged home without following a downhill course.

Omental flap creation using the left gastroepiploic artery and vein as the pedicle may be a beneficial method that is able to cope with both omental flap implantation to the posterior mediastinum and esophageal reconstruction with the gastric tube through a two-stage approach.