Transhiatal esophagectomy on a patient with aberrant right subclavian artery: A case report

INTRODUCTION: Esophageal dissection is generally safe and easy during transhiatal esophagectomy (THE). The right subclavian artery crosses between the esophagus and spine in about 1 % to 2 % of cases. This condition is called aberrant right subclavian artery and is the most common congenital aortic arch anomaly. Pre-operative recognition of this anomaly is important in esophageal surgeries. In unprepared situations injury to this vessel may result in life threatening bleeding. CASE PRESENTATION: A 45 year old female patient presented with progressive dysphagia and weight loss. Esophageal mass was found during upper gastrointestinal endoscopy. Additionally, a CT scan of the thorax and abdomen revealed an aberrant right subclavian artery and a distal esophageal mass. Biopsy revealed squamous cell carcinoma. A transhiatal esophagectomy was performed successfully with no complications. DISCUSSION: The vast majority of patients with an aberrant right subclavian artery do not experience any symptoms. In rare cases, patients may present with dysphagia (dysphagia lusoria) and obstructive respiratory symptoms in their fourth or fifth decade. When patients present with dysphagia from esophageal cancer, careful review of imaging is needed to identify the aberrant artery. CONCLUSION: The presence of aberrant right subclavian artery causes difficulty in performing esophagectomy. If it is diagnosed preoperatively, cautious retroesophageal dissection prevents injury to this vessel and complications following it.