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.
METHODS: 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.
CONCLUSIONS: 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.
METHODS: 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.
CONCLUSIONS: 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.
摘要：
背景：胸主动脉腔内修复术（TEVAR）治疗外伤性主动脉瘤破裂后食管坏死和穿孔极为罕见。很难管理，患者很少在没有治疗的情况下存活。虽然,关于我们提出的两种危及生命的疾病的后续成功治疗的最佳治疗方法,目前尚无一定的共识.
方法：一名52岁的男子在机动车碰撞后经历了钝性胸部创伤，轻微的疼痛和肋骨骨折症状。在第12天，他出现了严重的胸痛，计算机断层扫描（CT）显示外伤性胸主动脉瘤破裂，并伴有大量纵隔血肿。进行了紧急的胸主动脉腔内修复术（TEVAR）。几天后，患者出现发烧。CT怀疑纵隔气肿,食道破裂的迹象,但未获得食管造影和食管镜检查的证实。因为败血症恶化,患者被转诊为剖胸探查术.发现了破裂并进行了食管切除术,食管造口术和胃造口术以实现肠内营养。食管切除术后将近一年，通过胸骨后途径进行胃导管重建。重建后1年以上，患者仍然活着，无症状，未观察到支架移植物感染。
结论：我们成功治疗了一例特伐他汀治疗外伤性胸主动脉瘤破裂后食管坏死的罕见病例。早期诊断食管坏死并提供适当的治疗以提高生存率至关重要。
方法：一名52岁的男子在机动车碰撞后经历了钝性胸部创伤，轻微的疼痛和肋骨骨折症状。在第12天，他出现了严重的胸痛，计算机断层扫描（CT）显示外伤性胸主动脉瘤破裂，并伴有大量纵隔血肿。进行了紧急的胸主动脉腔内修复术（TEVAR）。几天后，患者出现发烧。CT怀疑纵隔气肿,食道破裂的迹象,但未获得食管造影和食管镜检查的证实。因为败血症恶化,患者被转诊为剖胸探查术.发现了破裂并进行了食管切除术,食管造口术和胃造口术以实现肠内营养。食管切除术后将近一年，通过胸骨后途径进行胃导管重建。重建后1年以上，患者仍然活着，无症状，未观察到支架移植物感染。
结论：我们成功治疗了一例特伐他汀治疗外伤性胸主动脉瘤破裂后食管坏死的罕见病例。早期诊断食管坏死并提供适当的治疗以提高生存率至关重要。
