Cases reported "Aortic Rupture"

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1/25. Primary aortoesophageal fistula: presenting as massive upper gastrointestinal hemorrhage.

    Primary aortoesophageal fistula is a rare cause of upper gastrointestinal bleeding. A six-year-old boy presented with massive upper gastrointestinal hemorrhage. endoscopy revealed a submucosal bulge in the esophagus with an ulcer and clot at the top. Lateral skiagram of the chest showed a posterior mediastinal mass. CT scan of the chest revealed a ruptured aortic aneurysm into the oesophagus, confirmed the diagnosis. The patient succumbed to the illness before he could be subjected to definitive treatment.
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2/25. Intraoesophageal rupture of a thoracic aortic aneurysm.

    The intraoesophageal rupture of a large thoracic aortic aneurysm is reported in a 49 year old man. He had been hypertensive for some years while the aneurysm increased in size. Although a graft was successfully inserted to repair the leak, infection from the oesophagus with candida albicans, subsequently led to secondary haemorrhage and death 17 days later. A plea is made for the earlier referral of patients with aneurysm prior to rupture, as the operative mortality rises markedly after rupture has occurred and in this case the situation was virtually irreparable.
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3/25. Percutaneous endovascular stent-graft placement for the treatment of acute rupture of an aneurysm of the thoracic aorta.

    A 68-year-old male patient presented with massive hematemesis following the acute rupture of an aneurysm of the descending thoracic aorta into the esophagus. In view of the important cardiac and pulmonary comorbidities, surgical treatment was excluded and successful percutaneous implantation of an endovascular stent-graft in the descending aorta was performed. In selected patients endovascular treatment may constitute an alternative to the surgical repair of ruptured aortic aneurysms.
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4/25. Delayed aortic rupture after radiochemotherapy and esophagectomy for esophageal cancer.

    Spontaneous rupture of major vessels is a known though rare complication in treatment of patients with esophageal cancer, but its pathophysiology is not very well understood. We herein report about the sudden death of a 42-year-old man due to spontaneous aortic rupture, 11 days after transthoracic esophagectomy. Because of a locally advanced squamous cell carcinoma of the distal esophagus, which was considered irresectable at the time of presentation, the patient had received one course of chemotherapy followed by synchronous chemoradiation (60 Gy, 5-fluorouracil and cisplatin) prior to surgery. We discuss the patho-anatomic findings of the postmortem examination concerning alterations of the aortic wall and the potential correlations with aggressive radiochemotherapy protocols.
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5/25. A case of an upper gastrointestinal bleeding due to a ruptured dissection of a right aortic arch.

    We report a case of severe upper gastrointestinal hemorrhage with a rare underlying cause. The patient was unconscious when he was admitted to the hospital. No chest radiogram was performed. Routine diagnostic measures, including endoscopy, failed to reveal the origin of the bleeding, which was believed to originate from the esophagus secondary to a peptic ulcer or varices. Exploratory laparotomy added no further information, but contrast-enhanced multislice computed tomography (MSCT) of the chest showed dextroposition of the widened aortic arch with a ruptured type-B dissection and a consecutive aorto-esophageal fistula (AEF). The patient died on the day of admission. Noninvasive MSCT angiography gives rapid diagnostic information on patients with occult upper gastrointestinal bleeding and should be considered before more invasive conventional angiography or surgery.
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6/25. esophageal perforation of aortic arch aneurysm treated free of mediastinitis without manipulating esophagus.

    Esophageal perforations of thoracic aortic aneurysms are most likely to be fatal. patients with aortoesophageal fistula require urgent operation on both the esophageal perforation site and the aortic lesion to avoid terminal exsanguination and uncontrollable mediastinitis. We present a case of 71-year-old woman suffering esophageal perforation of aortic arch aneurysm with sentinel arterial hemorrhage, who has not developed patent aortoesophageal fistula. Computed tomography verified rupture of aortic arch aneurysm that had eroded the esophagus. She underwent successful graft replacement and remains well without signs of mediastinitis over one year after the event. It is possible, in selected cases of esophageal perforation of thoracic aortic aneurysm, to manage the esophageal lesion without any surgical intervention, such as primary closure, omental coverage and surgical discontinuity to achieve esophageal healing free of infection.
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ranking = 2.5
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7/25. Ischemic esophageal necrosis secondary to traumatic aortic transection.

    Esophageal necrosis with perforation secondary to traumatic aortic transection is extremely rare but usually fatal. A 47-year-old man complained of sudden swallowing difficulty 6 days after blunt trauma. Computed tomography showed a ruptured aorta and the midesophagus shifted to the right side with luminal obliteration because of the ruptured aorta. After primary repair of the partially transected aorta, unexpected mediastinitis because of esophageal perforation was noted. Upper endoscopy showed midesophageal ulceration, necrosis, and perforation. biopsy samples were consistent with ischemia. The possibility of direct esophageal trauma or intraoperative esophageal injury was ruled out. Esophageal exclusion with thoracoscopic decortication and multiple antibiotics were ineffective, and the patient eventually died. Ischemic esophageal necrosis caused by mechanical compression can occur in a traumatic aortic transection. Dysphagia, when present with radiologic signs, indicates a displaced and compressed esophagus. In spite of aggressive surgical and medical treatment for a perforated esophagus, the prognosis remains poor.
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8/25. Bronchoesophageal fistula after endovascular repair of ruptured aneurysm of the descending thoracic aorta.

    Aortoesophageal fistula secondary to thoracic aneurysm is rare and is usually fatal without prompt surgical intervention. A 79-year-old man with significant comorbidities and previous cancer surgery was admitted on an emergency basis because of the suspicion of a ruptured thoracic aortic aneurysm. Computed tomographic scan followed by angiography demonstrated a ruptured thoracic aneurysm with aortoesophageal fistula. An endovascular stent graft repair was performed with successful exclusion of both aneurysm and fistula. On postoperative day 6, dyspnea and an isolated episode of hemoptysis occurred. endoscopy revealed the presence of a bronchoesophageal fistula, which necessitated double exclusion of the esophagus and feeding jejunostomy. At 6 months, clinical, bronchoscopic, and computed tomographic scan follow-up showed complete sealing of the aneurysm and resolution of the bronchoesophageal fistula. At 9 months, the patient was still alive but refused to undergo substernal gastric bypass in an attempt to restore oral feeding. Endovascular repair seems promising as an emergent and palliative treatment of aortoesophageal fistula. To the best of our knowledge, this is the first case in which a bronchoesophageal fistula developed after successful endovascular repair of aortoesophageal fistula. The pathogenesis of this complications remains unclear.
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9/25. Delayed esophageal necrosis and perforation secondary to thoracic aortic rupture: a case report and review of the literature.

    Delayed esophageal necrosis secondary to aortic rupture is extremely rare but potentially fatal. Although diagnostic techniques have improved, survival remains rare. The clinical and imaging features have not been characterized, as no large series have been reported since the advent of computed tomography (CT) and endoscopy. Moreover, as delayed esophageal necrosis secondary to aortic rupture is rarely anticipated, diagnosis is usually delayed. We recently encountered a case of this complication and present this along with a literature review, in order to facilitate early recognition and treatment. In many cases, hemodynamics remain relatively stable despite aortic rupture and the long interval between onset and operation. Dysphagia is therefore an important symptom that may indicate compression of the esophagus and subsequent esophageal necrosis. Preoperative total obstruction of the esophagus on barium swallow, endoscopy, or CT is also an important feature suggesting ischemic change of the esophagus. endoscopy often reveals an annular ulcer suggestive of an ischemic process leading to necrosis. death generally occurs from severe mediastinitis occurring after graft repair of the aorta. We recommend performing postoperative endoscopy after aortic surgery when preoperative obstruction of esophagus is found. If endoscopy reveals annular necrosis, surgical treatment involving esophagectomy and omental translocation should be performed expediently before perforation occurs.
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10/25. Roentgen findings in aorto-enteric fistulae.

    Six cases of aorto-enteric fistulas are discussed. In three patients the aorta ruptured into the duodenum and in three there was rupture into the esophagus. Aorto-enteric fistula is usually caused by atherosclerosis, but may also be due to syphilis or tuberculosis. Following insertion of an aortic graft, fistula is usually the result of breakdown of the anastomosis. Gastrointestinal bleeding usually heralds the problem. The roentgen signs of rupture are pressure on the esophagus or intestine, bleeding into the wall or lumen, and demonstration of the fistula. The abnormal connection may not be demonstrable by aortography. These signs permit early diagnosis and subsequent possible life saving surgical correction.
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