Oesophageal Perforation with Associated Thoracic Aortic Pseudoaneurysm Managed with Thoracic Endovascular Aortic Repair and Oesophageal Diversion: A Case Report

Introduction Oesophageal perforation with secondary involvement of the thoracic aorta is rare and may result in pseudoaneurysm formation, catastrophic haemorrhage, mediastinal sepsis, and endograft infection. Distinguishing an aortic pseudoaneurysm adjacent to an oesophageal defect from a definite aorto-oesophageal fistula is important for diagnosis and management. Case Description A 72-year-old woman presented after 10 days of progressive retrosternal pain radiating to the back, odynophagia, and dysphagia. Endoscopy demonstrated food impaction and mid-oesophageal mucosal irregularity without a definite transmural defect. Computed tomography angiography showed mediastinal air adjacent to the oesophagus and a thoracic aortic pseudoaneurysm distal to the left subclavian artery, without active contrast extravasation or a definite fistulous tract. Urgent thoracic endovascular aortic repair excluded the pseudoaneurysm, followed by cervical oesophagostomy, gastrostomy, feeding jejunostomy, and mediastinal drainage for source control. Discussion This case illustrates a staged multidisciplinary strategy in which endovascular aortic exclusion provides rapid protection from rupture while oesophageal diversion addresses mediastinal contamination. Detailed procedural, microbiological, antimicrobial, and follow-up data are important because persistent infection and endograft infection remain major concerns in this rare setting.