Korean J Thorac Cardiovasc Surg.  2010 Dec;43(6):753-757.

Double Bypass of Esophagus and Descending Thoracic Aorta for the Treatment of Esophagopleural and Aortopleural Fistula

• Park SJ
• Kang CH
• Kim KH
• Yoo B
• Kim YT
• Kim JH

Abstract

We report here on a case of double bypass of the esophagus and descending thoracic aorta for the treatment of esophagopleural fistula and aortopleural fistula due to an infected aortic aneurysm after esophageal rupture. A 48 year old man was diagnosed as having esophageal rupture after an accidental explosion. Although he had been treated by esophageal repair and drainage at another hospital, the esophageal leakage could not be controlled and subsequent empyema developed in the left pleura. Further, bleeding from the descending thoracic aorta had developed and he was managed with endovascular stent insertion to the descending thoracic aorta. He was transferred to our hospital for corrective surgery. We performed esophago - gastrostomy via the substernal route, without exploring posterior mediastinum and we let the empyema resolve spontaneously. While he was being managed postoperatively without any signs and symptoms of infection, sudden bleeding developed from the left pleural cavity. After evaluation for the bleeding focus, we discovered an infected aortic aneurysm and an aortopleural fistula at the stent insertion site. We performed a second bypass procedure for the infected descending thoracic aorta from the ascending aorta to the descending abdominal aorta via the right pleural cavity. We found leakage at the distal ligation site during the immediate postoperative period, and we occluded the leakage using a vascular plug. He discharged without complications and he is currently doing well without any more bleeding or other complications.

Keyword

Esophageal perforation; Empyema, pleural; Esophageal surgery; Aneurysm, infected

MeSH Terms

Aneurysm, Infected
Aorta
Aorta, Abdominal
Aorta, Thoracic
Aortic Aneurysm
Drainage
Empyema
Empyema, Pleural
Esophageal Perforation
Esophagus
Explosions
Fistula
Gastrostomy
Hemorrhage
Ligation
Linear Energy Transfer
Mediastinum
Pleura
Pleural Cavity
Postoperative Period
Rupture
Stents