Images in Cardiothoracic Medicine and Surgery

Unchanged esophageal perforation after total aortic arch replacement

Asian Cardiovascular & Thoracic Annals 2016, Vol. 24(4) 399 ß The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0218492314556549 aan.sagepub.com

Kazuhisa Matsumoto, Hiroyuki Yamamoto and Yutaka Imoto

Figure 2. (a) Esophagography showing an esophageal diverticulum. (b) Endoscopy revealed 2 holes in the diverticulum with a visibly exposed graft. Figure 1. Computed tomography revealing air bubbles around the distal aortic arch and the protruding esophagus on the aortic side (arrow).

A 77-year-old man underwent total aortic arch replacement, concomitant coronary artery bypass grafting, and the maze procedure. Three years later, he presented with chest pain and septic shock. A blood culture was positive for Streptococcus anginosus. Computed tomography revealed a gas formation abutting the graft (Figure 1). Esophagography and endoscopy confirmed the diagnosis of esophageal perforation, compatible with perforation of the Rokitansky diverticulum (Figure 2). The patient recovered from this acute condition with conservative treatment; however, he refused

definitive surgery and was discharged from the hospital. Since then, he has been hospitalized 4 more times for similar situations and he continues to receive oral antibiotics. He is leading a normal daily life and has normal eating habits. Declaration of conflicting interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding The author(s) received no financial support for the research, authorship, and/or publication of this article.

Department of Cardiovascular and Gastroenterological Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan Corresponding author: Kazuhisa Matsumoto, MD, Department of Cardiovascular and Gastroenterological Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan. Email: [email protected]

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Unchanged esophageal perforation after total aortic arch replacement.

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