Iatrogenic thoracic aortic injury in esophagectomy - a case report and literature review
Language English Country Czech Republic Media print
Document type Case Reports, Journal Article, Review
PubMed
31331183
PII: 113124
Knihovny.cz E-resources
- Keywords
- cancer of the esophagus, esophagectomy, injury of the aorta,
- MeSH
- Esophagectomy * adverse effects MeSH
- Iatrogenic Disease * MeSH
- Middle Aged MeSH
- Humans MeSH
- Esophageal Neoplasms * surgery MeSH
- Positron Emission Tomography Computed Tomography MeSH
- Prone Position MeSH
- Thoracoscopy MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Publication type
- Journal Article MeSH
- Case Reports MeSH
- Review MeSH
INTRODUCTION: This case report describes bleeding from an iatrogenic thoracic aortic injury in minimally invasive thoracoscopic esophagectomy. CASE REPORT: A 53-year-old man underwent neoadjuvant radiochemotherapy for adenocarcinoma of the esophagus with positive lymph nodes. PET/CT showed only a partial response after neoadjuvant therapy. Minimally invasive thoracoscopic esophagectomy in the semi-prone position with selective intubation of the left lung was performed. However, massive bleeding from the thoracic aorta during separation of the tumor resulted in conversion from minimally invasive to conventional right thoracotomy. The bleeding was caused by a five millimeter rupture of the thoracic aorta. The thoracic aortic rupture was treated by suture with a gore prosthesis in collaboration with a vascular surgeon. Esophagestomy was not completed due to hypovolemic shock. Hybrid transhiatal esophagectomy was performed on the seventh day after the primary operation. Definitive histological examination showed T3N3M0 adenocarcinoma. CONCLUSION: Esophagectomy for cancer of the esophagus is one of the most difficult operations in general surgery in which surgical bleeding from the surrounding structures cannot be excluded. Aortic hemorrhage is hemodynamically significant in all cases and requires urgent surgical treatment.