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Ann Thorac Surg 2004;78:2175-2178
© 2004 The Society of Thoracic Surgeons

Case report

Ischemic Esophageal Necrosis Secondary to Traumatic Aortic Transection

Nam-Hee Park, MDa, Jae-Hyun Kim, MDa, Dae-Yung Choi, MDa, Sae-Young Choi, MDa,*, Chang-Kwon Park, MDa, Kwang-Sook Lee, MDa, Seong-Wook Han, MDb, Young-Sun Yoo, MDa

a Departments of Thoracic and Cardiovascular Surgery, Keimyung University, Dongsan Medical Center, Daegu, South Korea
b Internal Medicine, Keimyung University, Dongsan Medical Center, Daegu, Republic of South Korea

Accepted for publication July 25, 2003.

* Address reprint requests to Dr Choi, Department of Thoracic and Cardiovascular Surgery, Keimyung University, Dongsan Medical Center, 194 Dongsan-dong, Jung-gu, Daegu, Republic of South Korea 700-712
sy56218{at}dsmc.or.kr

Esophageal necrosis with perforation secondary to traumatic aortic transection is extremely rare but usually fatal. A 47-year-old man complained of sudden swallowing difficulty 6 days after blunt trauma. Computed tomography showed a ruptured aorta and the midesophagus shifted to the right side with luminal obliteration because of the ruptured aorta. After primary repair of the partially transected aorta, unexpected mediastinitis because of esophageal perforation was noted. Upper endoscopy showed midesophageal ulceration, necrosis, and perforation. Biopsy samples were consistent with ischemia. The possibility of direct esophageal trauma or intraoperative esophageal injury was ruled out. Esophageal exclusion with thoracoscopic decortication and multiple antibiotics were ineffective, and the patient eventually died. Ischemic esophageal necrosis caused by mechanical compression can occur in a traumatic aortic transection. Dysphagia, when present with radiologic signs, indicates a displaced and compressed esophagus. In spite of aggressive surgical and medical treatment for a perforated esophagus, the prognosis remains poor.






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Copyright © 2004 by The Society of Thoracic Surgeons.