A 62-year-old male patient with a history of smoking (20 packs/year) presented with dysphagia and weight loss.
Upper gastrointestinal endoscopy showed a stenosing tumor of the esophagus 30 cm from the dental arch.
Biopsy confirmed a moderately differentiated squamous cell carcinoma.
The etapi-fication study with computed axial tomography (CAT) showed 50% of its posterior pulmonary lesion in the middle third of the esophagus, from the aortic arch to the abdomen more circumferential aspect.
He also had a 1 x 0.5 cm pulmonary nodule in the right upper lobe and a 3 cm hepatic nodule in the caudate lobe, compatible with secondary locations (T4NxM1).
Considering that the patient had metastatic cancer, he received palliative treatment for the relief of his dysphagia with CRT concomitant with cisplatin chemotherapy (51 Gy in 17 Gy and cisplatin 40 mg/ m2 weekly).
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Two months after the treatment was completed, the patient was seen in the emergency department due to sepsis; on admission, hypotensive and tachycardic, he recovered his hemodynamics by crystalloid delivery.
Haematoma, 21%.
AngioTAC showed reduction of esophageal tumor mass with central necrotic component and without anterior wall of the aorta, without evidence of active bleeding; the findings were suggestive of an AED.
The patient was taken to the operating room where a Valiant 28 x 15 endoprosthesis (Mintronic, Medine femoral, USA) was implanted without incident proximal descending thoracic aorta, distal to the left subclavian artery.
Antibiotic coverage was initiated based on ce-ftriaxone and clindamycin.
Gastrointestinal bleeding did not recur, starting progressive oral feeding on the 4th postoperative day, without evidence of dysphagia.
She was discharged on the 8th day with good oral tolerance and affliction.
He completed 14 days of intravenous antibiotics and then continued with amoxicillin/clavulanic acid and amoxicillin indefinitely thereafter.
In outpatient controls with known metastases and without dysphagia or fever and progressive weight gain of 6 kg. Control angioCT at 3 months showed adequate position of the stent without progression of hepatic leakage.
Palliative care was continued and the patient presented no major complications until 11 months after the procedure. The patient reported general health problems, dysphagia to solids and weight loss of 10 kilos.
ADD showed stenosing esophageal lesion from 30 to 35 cm of the dental arch with exposure to aortic endoprosthesis.
Palliative management was maintained and the patient finally died 13 months after surgery without evidence of sepsis or new bleeding episodes.
