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J Thorac Cardiovasc Surg 2008;136:1091-1093
© 2008 The American Association for Thoracic Surgery

Brief Communication

Aortoesophageal fistula associated with a Kommerell diverticulum and right-sided aortic arch

^a Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio
^b Metrohealth Medical Center, Cleveland, Ohio

Received for publication November 15, 2007; accepted for publication November 25, 2007.

^_* Address for reprints: Karl G. Reyes, MD, Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, 9500 Euclid Ave H35, Cleveland, OH 44195. (Email: reyesk2@ccf.org).

The first 20% of the full text of this article appears below.

Aortoesophageal fistula (AEF) is rare and often fatal complication of vehicular trauma. In the past, it has also been reported in the presence of congenital arch anomalies. We report here a case of traumatic AEF in a patient with both a right-sided aortic arch and a Kommerell diverticulum, the first such in the literature, as well as its successful management by staged open surgical repair.

Clinical Summary

A 26-year-old man was taken to the emergency department after a vehicular crash in which he had been the ejected, unrestrained driver. Injuries noted on admission were primarily intracranial, with a depressed mental status necessitating mechanical ventilation. The patient's mental status eventually improved to the point at which he could be weaned from the ventilator and required only a percutaneous endoscopic gastrostomy tube for feeding. He was discharged to a rehabilitation center 3 weeks later.

During the patient's stay at the rehabilitation center, approximately 4 weeks after the crash, he had massive gastrointestinal bleeding, with bright red blood coming out of his percutaneous endoscopic gastrostomy tube. The patient was taken to a nearby hospital, where he was resuscitated and subsequently taken to the endoscopy suite. On esophagogastroscopy, large amounts of blood and blood clots were seen, but with no identifiable source of bleeding. Because of the suddenness of the event, the diagnosis of AEF was considered, and the patient was flown to our institution. On arrival, the patient had no active bleeding. Diagnostic studies included chest radiography, results of which were unremarkable except for findings suggestive of a right-sided aortic arch. Chest CT scan ( Figure 1) confirmed the presence of a . . . [Full Text of this Article]