รายงานผู้ป่วยกิตติชัย Vol. 56 เล่ม 1 หน้า 71-77.pmd

Esophageal necrosis is a rare complication of treatment of the descending thoracic or thoraco-abdominal aortic aneurysm. It is almost always fatal. Sepsis and bleeding secondary to dehiscence of the aorticgraft suture line are main mechanisms of death. However, these patients can be saved by aggressive medical and surgical treatment. A 40-year-old male was transferred to this hospital because of severe epigastric pain secondary to concealed rupture of a descending aortic aneurysm. Urgent aneurysmectomy and bypass graft was done using “clamp-and-go technique”. He was in septic conditions approximately a week later. An abscess around the graft was confirmed by CT scan. The second operation was taken; the findings were necrosis of the lower esophagus with heavy contamination around the graft. The contaminations were removed as much as possible by saline irrigation and some suspicious aortic aneurysmal wall was resected then the graft was covered with pedical omental flap. Also, esophagectomy, gastrostomy, and feeding jejunostomy were done. Intravenous antibiotics were continued. His septic conditions seemed to be improved. Three weeks later, he became febrile due to remaining collections surrounding the graft. The third operation was taken in order to do another aggressive debridement and irrigation. Finally, he had no more the aortic infection and was discharged. Duration of all the mentioned treatments was approximately 5 months. A month later, reconstruction of the esophagus with colon was รายงานผู ป่้วย