A rare case of posttraumatic aortic rupture, treated with an endovascular stent graft implantation and complicated with esophageal rupture
Abstract Background Esophageal necrosis and perforation after thoracic endovascular aortic repair (TEVAR) for ruptured traumatic aortic aneurysm is extremely rare. It is difficult to manage, and patients rarely survive without treatment. Although, there is no certain consensus in relation with the o...
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| Format: | Article |
| Language: | English |
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BMC
2022-08-01
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| Series: | Journal of Cardiothoracic Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13019-022-01955-y |
| _version_ | 1817999059359629312 |
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| author | Dimitar Kyuchukov Peyo Simeonov Gencho Nachev Magdalena Alexieva Georgi Yankov |
| author_facet | Dimitar Kyuchukov Peyo Simeonov Gencho Nachev Magdalena Alexieva Georgi Yankov |
| author_sort | Dimitar Kyuchukov |
| collection | DOAJ |
| description | Abstract Background Esophageal necrosis and perforation after thoracic endovascular aortic repair (TEVAR) for ruptured traumatic aortic aneurysm is extremely rare. It is difficult to manage, and patients rarely survive without treatment. Although, there is no certain consensus in relation with the optimal treatment we present a subsequent successful management of both life-threatening conditions. Case presentation A 52-year-old man experienced a blunt chest trauma after motor vehicle collision with mild symptoms of pain and fractured ribs. On the 12th day he had severe chest pain and computed tomography (CT) revealed a ruptured traumatic thoracic aortic aneurysm with massive mediastinal hematoma. An emergency thoracic endovascular aortic repair (TEVAR) was performed. Several days later the patient developed a fever. CT suspected a pneumomediastinum, a sign of esophageal rupture, but no confirmation from esophagography and esophagoscopy was achieved. Because of deteriorated septic condition, patient was referred for exploratory thoracotomy. The rupture was found and esophagectomy was performed, with an esophagostomy and gastrostomy to enable enteral nutrition. Almost one year after the esophagectomy, gastric conduit reconstruction through the retrosternal route was performed. The patient was still alive and symptom-free more than 1 year after the reconstruction and no infection of the stent graft was observed. Conclusion We successfully managed a rare case of esophageal necrosis after TEVAR for ruptured traumatic thoracic aortic aneurysm. It is essential to diagnose the esophageal necrosis at an early stage and provide appropriate treatment to increase survival. |
| first_indexed | 2024-04-14T03:02:55Z |
| format | Article |
| id | doaj.art-99c893519d314a0bb60e58439330786c |
| institution | Directory Open Access Journal |
| issn | 1749-8090 |
| language | English |
| last_indexed | 2024-04-14T03:02:55Z |
| publishDate | 2022-08-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Cardiothoracic Surgery |
| spelling | doaj.art-99c893519d314a0bb60e58439330786c2022-12-22T02:15:52ZengBMCJournal of Cardiothoracic Surgery1749-80902022-08-011711710.1186/s13019-022-01955-yA rare case of posttraumatic aortic rupture, treated with an endovascular stent graft implantation and complicated with esophageal ruptureDimitar Kyuchukov0Peyo Simeonov1Gencho Nachev2Magdalena Alexieva3Georgi Yankov4Heart Surgery Department, UMBAL “St. Ekaterina”- Medical University of SofiaHeart Surgery Department, UMBAL “St. Ekaterina”- Medical University of SofiaHeart Surgery Department, UMBAL “St. Ekaterina”- Medical University of SofiaThoracic Surgery Department, MBALBB “St. Sofia”- Medical University of SofiaThoracic Surgery Department, MBALBB “St. Sofia”- Medical University of SofiaAbstract Background Esophageal necrosis and perforation after thoracic endovascular aortic repair (TEVAR) for ruptured traumatic aortic aneurysm is extremely rare. It is difficult to manage, and patients rarely survive without treatment. Although, there is no certain consensus in relation with the optimal treatment we present a subsequent successful management of both life-threatening conditions. Case presentation A 52-year-old man experienced a blunt chest trauma after motor vehicle collision with mild symptoms of pain and fractured ribs. On the 12th day he had severe chest pain and computed tomography (CT) revealed a ruptured traumatic thoracic aortic aneurysm with massive mediastinal hematoma. An emergency thoracic endovascular aortic repair (TEVAR) was performed. Several days later the patient developed a fever. CT suspected a pneumomediastinum, a sign of esophageal rupture, but no confirmation from esophagography and esophagoscopy was achieved. Because of deteriorated septic condition, patient was referred for exploratory thoracotomy. The rupture was found and esophagectomy was performed, with an esophagostomy and gastrostomy to enable enteral nutrition. Almost one year after the esophagectomy, gastric conduit reconstruction through the retrosternal route was performed. The patient was still alive and symptom-free more than 1 year after the reconstruction and no infection of the stent graft was observed. Conclusion We successfully managed a rare case of esophageal necrosis after TEVAR for ruptured traumatic thoracic aortic aneurysm. It is essential to diagnose the esophageal necrosis at an early stage and provide appropriate treatment to increase survival.https://doi.org/10.1186/s13019-022-01955-yAortic ruptureThoracic endovascular aortic repairEsophageal necrosisEsophagectomy |
| spellingShingle | Dimitar Kyuchukov Peyo Simeonov Gencho Nachev Magdalena Alexieva Georgi Yankov A rare case of posttraumatic aortic rupture, treated with an endovascular stent graft implantation and complicated with esophageal rupture Journal of Cardiothoracic Surgery Aortic rupture Thoracic endovascular aortic repair Esophageal necrosis Esophagectomy |
| title | A rare case of posttraumatic aortic rupture, treated with an endovascular stent graft implantation and complicated with esophageal rupture |
| title_full | A rare case of posttraumatic aortic rupture, treated with an endovascular stent graft implantation and complicated with esophageal rupture |
| title_fullStr | A rare case of posttraumatic aortic rupture, treated with an endovascular stent graft implantation and complicated with esophageal rupture |
| title_full_unstemmed | A rare case of posttraumatic aortic rupture, treated with an endovascular stent graft implantation and complicated with esophageal rupture |
| title_short | A rare case of posttraumatic aortic rupture, treated with an endovascular stent graft implantation and complicated with esophageal rupture |
| title_sort | rare case of posttraumatic aortic rupture treated with an endovascular stent graft implantation and complicated with esophageal rupture |
| topic | Aortic rupture Thoracic endovascular aortic repair Esophageal necrosis Esophagectomy |
| url | https://doi.org/10.1186/s13019-022-01955-y |
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