右側大動脈弓に伴うKommerell憩室と血管輪による嚥下困難・誤嚥性肺炎の1例

Dysphagia and Aspiration Pneumonia Caused by Kommerell’s Diverticulum and the Vascular Ring Associated with Right-sided Aortic Arch：Report of a Case

はじめに　右側大動脈弓やKommerell憩室は，胎生期にごくまれに生じる先天性の血管奇形である．解剖学的に血管が食道や気管を圧排しない限り，無症状で経過する．症状が出現したり，Kommerell憩室が拡大傾向を示した場合，手術を要することがある．われわれは，右側大動脈弓に伴うKommerell憩室が血管輪を形成することによって嚥下困難および誤嚥性肺炎をきたしたため，手術を行った症例を経験したので報告する．

We report a case of an 80-year-old man complaining of dysphagia followed by aspiration pneumonia. Computed tomography of the chest revealed Kommerell’s diverticulum associated with the right-sided aortic arch and the vascular ring which was formed by the aortic arch, the left subclavian artery, the ductus arteriosus, and the pulmonary artery around the esophagus and the trachea. Enlargement of the diverticulum was considered to be the cause of dysphagia. The surgery was performed at 20 ℃ under deep hypothermic circulatory arrest. We performed resection of the Kommerell’s diverticulum, reconstruction of the left subclavian artery, and transection of the ductus arteriosus to relieve the compression by the esophagus and the trachea. The postoperative course was uneventful and dysphagia disappeared.