A Case of Acute Stanford Type A Aortic Dissection after Retrosternal Gastric Tube Reconstruction for Esophageal Cancer

Kenta Uekihara, Takeshi Sakaguchi, Mai Matsukawa, Ryo Hirayama, Koji Hagio, Toshiaki Watanabe, Ryusuke Suzuki
2014 Japanese Journal of Cardiovascular Surgery  
An 80-year-old man presented with a history of retrosternal gastric tube reconstruction for esophageal cancer. He experienced sudden chest pain, and temporarily lost consciousness, before being transferred to our hospital. Contrast-enhanced computed tomography revealed acute Stanford type A aortic dissection and a retrosternal gastric tube. We performed emergency operation using a median sternotomy approach. Before median sternotomy, we detected the gastric tube in the subxiphoid and
more » ... l spaces. The anterior and right sides of the gastric tube were dissected bluntly from the posterior surface of the sternum and median sternotomy was performed. The gastric tube was mobilized to the left side and we were able to obtain the usual operative view for ascending aorta graft replacement. Intraoperatively, the gastric tube remained intact and uninjured. The patient was transferred to another hospital for rehabilitation on postoperative day 34. Jpn. J. Cardiovasc. Surg. 43 : 134-137(2014) Keywords:esophageal cancer ; retrosternal gastric tube reconstruction ; median sternotomy ; acute aortic dissection 近年,食道癌の分野では化学療法,放射線療法,内視鏡 治療,外科的手術といった集学的治療が行われ,その成績 が向上している.それに伴って,食道癌術後の患者に心臓 手術の適応となる症例報告が散見されている.今回われわ れは,19 年前に食道癌に対して,胃管を用いた胸骨後再 建施行後の急性大動脈解離を経験し,良好な結果を得たの で,そのアプローチに関する文献的考察も加えて報告す る. 症 例 症例:80 歳,男性. 既往歴:19 年前に他院で食道癌に対する食道亜全摘術, 胸骨後胃管再建. 現病歴:入浴後,一過性の意識消失発作を認め,意識レ ベル改善後より胸痛を自覚し,救急で,当院へ搬送され た. 入院時現症:身長 157 cm,体重 48 kg,血圧 134/103 mmHg 左右差なし,脈拍 67/分,体温 35.6 度. 胸部 X 線写真(臥位) :肺うっ血なし,縦隔拡大あり. 血液検査:WBC 8,130/μl,RBC 338 万/μl,Hgb 12.4 g/dl,Plt 12. 〒 861-8520 熊本市東区長嶺南 2-1-1 本研究において一切の利益相反や研究資金の提供はない. None of the authors of this manuscript has any financial or personal relationship with other people or organizations that could inappropriately influence their work.
doi:10.4326/jjcvs.43.134 fatcat:j5jkinu23raclhio752a75ri4e