抄録
A right-sided aortic arch is a rare congenital abnormality. Anatomical displacement of the intrathoracic cavity must be addressed when performing surgery for such patients. Here, we report a case of free jejunal transfer for reconstruction of an esophago-cutaneous fistula after resection of esophageal cancer in a patient with right-sided aortic arch. The patient was a 67-year-old male who had upper thoracic esophageal perforation due to invasion of esophageal carcinoma. The thoracic esophagus was resected and reconstruction was carried out with a gastric tube via the posterior sternal route. However, an esophago-cutaneous fistula developed after the operation and the patient consulted our department. A CT scan revealed that the gastric tube was crushed between the sternum and the aortic arch, which likely caused the circulatory impairment of the gastric tube. Surgery was planned to close the fistula. First, the sternum was partially resected to widen the reconstructed digestive route, and the defect in the esophagus was replaced with a free jejunal flap. The postoperative course was uneventful. In the present patient, anatomical displacement in the surgical area caused the complication in the primary operation. It is important to consider individual anatomical features when treating such patients.
