Aortoesophageal Fistula Associated with a Ruptured Chronic Type B Aortic Dissection and Right-sided Aortic Arch

Abstract

A 54-year-old man with chronic type B aortic dissection was referred to our hospital complaining of hematemesis and melena. Upper endoscopy revealed a spot defect in esophageal mucosa covered with blood clot. Contrast enhanced CT showed a ruptured descending aorta adjacent to the mid-esophagus. Right-sided aortic arch and aberrant left subclavian artery from Kommerrell’s diverticulum were also revealed. Descending aortic replacement and left subclavian artery reconstruction via right thoracotomy and omentopexy were performed. Cervical esophagostomy and gastrostomy were performed, simultaneously. The postoperative course was uneventful. We report a rare case of an aortoesophageal fistula associated with a ruptured chronic type B aortic dissection and right-sided aortic arch.