食道異物による大動脈損傷に対して胸部ステントグラフト内挿術を施行した1例

Endovascular Repair of Aortic Injury Caused by Esophageal Foreign Body：Report of a Case

はじめに　食道異物穿孔による大動脈損傷はきわめてまれであるが致命的となりうる．従来治療は人工血管置換術とされてきたものの，侵襲が大きく治療成績は不良であった．近年，侵襲軽減を目的に胸部ステントグラフト内挿術（TEVAR）による治療報告が散見される．われわれは，食道異物穿孔による大動脈損傷に対してTEVARと抗菌薬治療で良好な長期成績が得られた症例を経験したので報告する．

A 51-year-old man visited to our hospital because of chest discomfort and hematemesis. He was diagnosed with Mallory-Weiss syndrome and followed in outpatient clinic. One week later, he visited our hospital again for fever and discomfort. Chest computed tomography （CT） showed a foreign body perforated in the mediastinum in the upper esophagus, and he was urgently hospitalized for surgical removal of esophageal foreign body. Before surgery he vomited the esophageal foreign body with a lot of blood. Hematemesis was stopped spontaneously and contrast-enhanced CT revealed a pseudoaneurysm in the distal aortic arch, so thoracic endovascular aortic repair （TEVAR） was performed to prevent rupture. Esophageal endoscopy found that the site of esophageal injury healed spontaneously, so the patient was followed conservatively with antibiotics. He was discharged on postoperative day 18 uneventfully. TEVAR was an effective treatment for aortic injury caused by esophageal foreign body in our case.