Perforation of the esophagus by a fish bone leading to an infected pseudoaneurysm of the thoracic aorta

A 79-year-old woman was urgently referred to a district hospital with dull central chest pain after swallowing a fish bone. The bone was removed by esophagoscopy. Eleven days later she presented because of hematemesis. Computed tomography and aortic arch angiography confirmed a diagnosis of esophageal perforation leading to mediastinitis and the presence of an infected pseudoaneurysm. The infected pseudoaneurysm was completely resected, followed by direct aorto-aorta anastomosis and omental coverage in a one-stage operation. She improved and was discharged 2 months later.