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Abstract
Prolonged air leak or alveolar-pleural fistula is common after lung resection and can usually be managed with continued pleural drainage until resolution. Further management options include blood patch administration, chemical pleurodesis, and 1-way endobronchial valve placement. Bronchopleural fistula is rare but is associated with high mortality, often caused by development of concomitant empyema. Bronchopleural fistula should be confirmed with bronchoscopy, which may allow bronchoscopic intervention; however, transthoracic stump revision or window thoracostomy may be required.
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Affiliation(s)
- James M Clark
- Section of General Thoracic Surgery, Department of Surgery, University of California, Davis Health, 2335 Stockton Boulevard, 6th Floor North Addition Office Building, Sacramento, CA 95817, USA. https://twitter.com/JamesClarkMD
| | - David T Cooke
- Section of General Thoracic Surgery, Department of Surgery, University of California, Davis Health, 2335 Stockton Boulevard, 6th Floor North Addition Office Building, Sacramento, CA 95817, USA. https://twitter.com/DavidCookeMD
| | - Lisa M Brown
- Section of General Thoracic Surgery, Department of Surgery, University of California, Davis Health, 2335 Stockton Boulevard, 6th Floor North Addition Office Building, Sacramento, CA 95817, USA.
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2
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Abstract
Esophagectomy is a complex operation with many potential complications. Early recognition of postoperative complications allows for the best chance for patient survival. Diagnosis and management of conduit complications, including leak, necrosis, and conduit-airway fistulae, are reviewed. Other common complications, such as chylothorax and recurrent laryngeal nerve injury, also are discussed.
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Affiliation(s)
- Jonathan C Yeung
- Toronto General Hospital, 200 Elizabeth Street 9N-983, Toronto, Ontario M5G 2C4, Canada.
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3
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Maki Y, Fujikura Y, Tagami Y, Hamakawa Y, Sasaki H, Misawa K, Hayashi N, Kawana A. Empyema with Multiple Bronchopleural Fistulae Improved by Bronchial Occlusion Using an Endobronchial Watanabe Spigot with the Push and Slide Method. Intern Med 2019; 58:1315-1319. [PMID: 30568146 PMCID: PMC6543220 DOI: 10.2169/internalmedicine.1877-18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The push and slide method is a method of endoscopic bronchial occlusion using an endobronchial Watanabe spigot that facilitates occlusion of the target bronchus rapidly and accurately using a guidewire. We herein report the case of a man who was diagnosed with empyema forming bronchopulmonary fistulae that was successfully treated by endoscopic bronchial occlusion. Because of the multiple fistulae, balloon occlusion was not a favorable therapeutic approach. Instead, the push and slide method was used in order to detect the fistulae. Endoscopic occlusion, particularly that using the push and slide method, may be a valid treatment option for empyema with multiple bronchopulmonary fistulae.
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Affiliation(s)
- Yohei Maki
- Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, Japan
| | - Yuji Fujikura
- Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, Japan
| | - Yoichi Tagami
- Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, Japan
| | - Yusuke Hamakawa
- Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, Japan
| | - Hisashi Sasaki
- Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, Japan
| | - Kazuhisa Misawa
- Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, Japan
| | - Nobuyoshi Hayashi
- Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, Japan
| | - Akihiko Kawana
- Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, Japan
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4
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Wang H, Tao M, Zhang N, Zou H, Li D, Ma H, Zhou Y. Single application of airway stents in thoracogastric-airway fistula: results and prognostic factors for its healing. Ther Adv Respir Dis 2019; 13:1753466619871523. [PMID: 31476949 PMCID: PMC6724482 DOI: 10.1177/1753466619871523] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 07/29/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Thoracogastric-airway fistula (TGAF) post-thoracic surgery is a rare and challenging complication for esophagectomy. The aim of this study was to explore the effectiveness of airway stenting for TGAF patients and find related factors coupled with healing of fistula. METHODS This is a retrospective study involving patients with TGAF who were treated with airway stentings. Based on different TGAF locations and sizes on chest computed tomography, covered metallic or silicon airway stents were implanted to cover orifices under interventional bronchoscopy. TGAF healing was defined as the primary outcome, and complete sealing of TGAF as the second outcome. The predictors for TGAF healing were analyzed in univariate and multivariate analysis. RESULTS A total of 58 TGAF patients were included, of whom 7 received straight covered metallic stents, 5 straight silicon stents, 3 L-shaped covered metallic stents, 21 large Y-shaped covered metallic stents, 17 large Y-shaped silicon stents, and 5 with Y-shaped covered metallic stents. Healing was achieved in 20 (34.5%) patients, and complete sealing in 45 (77.6%) patients. There were no significant differences in healing rate and complete sealing rate between patients receiving metallic stents and those with silicon stents. In univariate analysis, lacking a previous history of radiotherapy or chemotherapy, nonmalignant fistulas, small fistulas, and shorter postesophagectomy duration were found associated with a higher rate of TGAF healing. Only shorter postesophagectomy duration was associated with TGAF healing in multivariate analysis. CONCLUSIONS Both silicon and covered metallic airway stenting are effective methods to close TGAF. A shorter postesophagectomy period may predict better TGAF healing. The reviews of this paper are available via the supplemental material section.
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Affiliation(s)
- Hongwu Wang
- Department of Oncology, Emergency General Hospital, No. 29 Xibahe Nanli, Chaoyang District, Beijing, 100028, China
| | - Meimei Tao
- Department of Oncology, Emergency General Hospital, No. 29 Xibahe Nanli, Chaoyang District, Beijing, 100028, China
| | - Nan Zhang
- Department of Oncology, Emergency General Hospital, Beijing, China
| | - Hang Zou
- Department of Oncology, Emergency General Hospital, Beijing, China
| | - Dongmei Li
- Department of Oncology, Emergency General Hospital, Beijing, China
| | - Hongming Ma
- Department of Oncology, Emergency General Hospital, Beijing, China
| | - Yunzhi Zhou
- Department of Oncology, Emergency General Hospital, Beijing, China
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5
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Abstract
Alveolar-pleural fistulas causing persistent air leaks (PALs) are associated with prolonged hospital stays and high morbidity. Prior guidelines recommend surgical repair as the gold standard for treatment, albeit it is a solution with limited success. In patients who have recently undergone thoracic surgery or in whom surgery would be contraindicated based on the severity of illness, there has been a lack of treatment options. This review describes a brief history of treatment guidelines for PALs. In the past 20 years, newer and less invasive treatment options have been developed. Aside from supportive care, the literature includes anecdotal successful reports using fibrin sealants, ethanol injection, metal coils, and Watanabe spigots. More recently, larger studies have demonstrated success with chemical pleurodesis, autologous blood patch pleurodesis, and endobronchial valves. This manuscript describes these treatment options in detail, including postprocedural adverse events. Further research, including randomized controlled trials with comparison of these options, are needed, as is long-term follow-up for these interventions.
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Affiliation(s)
- Karen C Dugan
- Department of Medicine, Section of Pulmonary and Critical Care, University of Chicago, Chicago, IL
| | - Balaji Laxmanan
- Department of Medicine, Section of Pulmonary and Critical Care, University of Chicago, Chicago, IL
| | - Septimiu Murgu
- Department of Medicine, Section of Pulmonary and Critical Care, University of Chicago, Chicago, IL
| | - D Kyle Hogarth
- Department of Medicine, Section of Pulmonary and Critical Care, University of Chicago, Chicago, IL.
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6
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Bassetti R, Werder P, Crameri M, Ebinger A, Stähli A, Mericske-Stern R, Kuttenberger J. The patent nasopalatine duct: a potential cause of unclear pain in the anterior maxilla. Quintessence Int 2016; 46:73-9. [PMID: 25262673 DOI: 10.3290/j.qi.a32815] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this report is to describe symptoms that can suggest the presence of a patent nasopalatine duct and to illustrate three cases. SUMMARY Patent nasopalatine ducts connecting the oral cavity with the nasal cavity are extremely rare. This malformation can be considered a developmental abnormality. Clinically, patent nasopalatine ducts appear as single or double spherical or oval apertures lateral or posterior to the incisive papilla. This type of anatomical malformation can be associated with an unclear pain sensation in the anterior maxillary region, which may be misinterpreted for example as toothache of endodontic origin. However, persisting nasopalatine ducts can also exist as an asymptomatic abnormality with no clinical sign of discomfort. Accordingly, understanding the differential diagnosis of a possible patent nasopalatine duct can prevent a general practitioner from performing unnecessary interventions, such as endodontic treatments, apical surgeries, or tooth extractions.
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Maizlin II, Chen JS, Smith NJ, Rogers DA. Closure of a Traumatic Esophagomediastinal Fistula in a Child by Endoscopic Fulguration and Fibrin Injection. Am Surg 2016; 82:789-791. [PMID: 27670565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Posttraumatic esophagomediastinal fistula is an uncommon clinical entity that warrants surgical awareness due to its life-threatening potential. Its management, especially in previously operated field, is controversial and several endoscopic methods are being proposed as alternatives. Ours is the first report of endoscopic fulguration and fibrin injection in successful closure of such fistula. A 9-year-old female sustained complete tracheoesophageal transection from a gunshot wound to the neck and underwent immediate primary repair. She presented nine months later with fevers and swelling over anterior neck. CT revealed air tracking posteriorly to the dorsal neck and inferiorly to the mediastinum. Considering difficulty of open surgical approach, endoscopic intervention was attempted. Posterior wall fistula was identified via microlaryngoscopy above the esophageal anastomosis. The fistula tract was de-epithelialized via a Bugbee fulgurating electrode and then sealed with fibrin glue. Consequent imaging studies demonstrated complete occlusion of the fistula. Posterior posttraumatic esophagomediastinal fistula presents a challenging scenario from a surgical standpoint, as it combines difficulty of safe approach, high rate of injury to surrounding structures, and significant postoperative recurrence rate. Endoscopic Bugbee fulguration and fibrin glue injection are a safe and effective alternative to the traditional approach.
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Affiliation(s)
- Ilan Igor Maizlin
- Division of Pediatric Surgery, Children's Hospital Of Alabama, University Of Alabama, Birmingham, Alabama, USA
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8
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Lao M, Gao X, Li J. [Interventional treatment of acquired respiratory fistulas]. Zhonghua Jie He He Hu Xi Za Zhi 2016; 39:221-223. [PMID: 26980539 DOI: 10.3760/cma.j.issn.1001-0939.2016.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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9
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Fiorelli A, Esposito G, Pedicelli I, Reginelli A, Esposito P, Santini M. Large tracheobronchial fistula due to esophageal stent migration: Let it be! Asian Cardiovasc Thorac Ann 2015; 23:1106-9. [PMID: 26045491 DOI: 10.1177/0218492315587816] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We report tracheal-bronchial migration of a covered esophageal self-expanding metal stent used to relieve dysphagia in a patient with advanced esophageal cancer. The stent eroded the trachea and completely occluded the main left bronchus. Surgery was contraindicated due to her poor clinical condition, and insertion of another stent in the trachea, esophagus, or both was contraindicated due to extension of the fistula. Esophageal exclusion with a combination of cervical esophagostomy and an enteral feeding tube was the only feasible treatment to minimize spoilage by aspirated saliva and provide enteral nutrition.
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Affiliation(s)
- Alfonso Fiorelli
- Thoracic Surgery Unit, Second University of Naples, Naples, Italy
| | | | - Ilaria Pedicelli
- Pneumology Unit, Pollena Trocchia Hospital, Pollena Trocchia, Italy
| | | | - Pasquale Esposito
- Gastrointestinal Endoscopy Unit, Second University of Naples, Naples, Italy
| | - Mario Santini
- Thoracic Surgery Unit, Second University of Naples, Naples, Italy
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10
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Abstract
BACKGROUND Prolonged air leaks may result in increased morbidity and mortality. Endobronchial valves have been used as a nonoperative treatment. We evaluated the efficacy of endobronchial valves at achieving chest tube removal and hospital discharge for air leaks resulting from varied etiologies. METHODS All consecutive patients undergoing endobronchial valve placement for persistent air leak were evaluated by a multidisciplinary team at a single institution. Those receiving valves underwent bronchoscopy with balloon occlusion to identify airways contributing to the leak. After airway sizing, unidirectional endobronchial valves were deployed. RESULTS During an 18-month period, 21 patients underwent 24 valve placement procedures; 88 valves were placed (median, 3; mean, 3.6; range, 1 to 12). Patient age range was 16 months to 70 years. The underlying cause of persistent air leak was postoperative (n = 8), pneumothorax (n = 11), cavitary lung infection (n = 3), and postpneumonectomy bronchopleural fistula (n = 2). There were no valve-related complications during placement, dwell time, or removal. Three patients died as a result of their underlying disease, unrelated to valves. Of those with chest tubes who survived and were discharged, all had successful removal of their chest tubes. Median duration to chest tube removal after initial valve placement was 15 days (mean, 21 days; range, 0 to 86 days). Median length of stay after final valve placement was 5 days (mean, 15 days; range, 0 to 196 days). CONCLUSIONS Challenging air leaks often occur in medically compromised patients. They may persist despite multiple interventions. Endobronchial valves offer minimally invasive management. Time to chest tube removal and length of stay are variable, frequently because of clinical status and underlying disease.
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Affiliation(s)
- Michael F Reed
- Department of Surgery, Division of Thoracic Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania.
| | - Christopher R Gilbert
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Matthew D Taylor
- Department of Surgery, Division of Thoracic Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Jennifer W Toth
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
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11
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Wang F, Yu H, Zhu MH, Li QP, Ge XX, Nie JJ, Miao L. Gastrotracheal fistula: Treatment with a covered elf-expanding Y-shaped metallic stent. World J Gastroenterol 2015; 21:1032-1035. [PMID: 25624743 PMCID: PMC4299322 DOI: 10.3748/wjg.v21.i3.1032] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 06/27/2014] [Accepted: 07/25/2014] [Indexed: 02/06/2023] Open
Abstract
A 67-year-old man had a sev-ere cough and pulmonary infection for 1 wk before seeking evaluation at our hospital. He had undergone esophagectomy with gastric pull-up and radiotherapy for esophageal cancer 3 years previously. After admission to our hospital, gastroscopy and bronchoscopy revealed a fistulous communication between the posterior tracheal wall near the carina and the upper residual stomach. We measured the diameter of the trachea and bronchus and determined the site and size of the fistula using multislice computed tomography and gastroscopy. A covered self-expanding Y-shaped metallic stent was implanted into the trachea and bronchus. Subsequently, the fistula was closed completely. The patient tolerated the stent well and had good palliation of his symptoms.
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12
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Petrella F, Spaggiari L, Acocella F, Barberis M, Bellomi M, Brizzola S, Donghi S, Giardina G, Giordano R, Guarize J, Lazzari L, Montemurro T, Pastano R, Rizzo S, Toffalorio F, Tosoni A, Zanotti M. Airway fistula closure after stem-cell infusion. N Engl J Med 2015; 372:96-7. [PMID: 25551543 DOI: 10.1056/nejmc1411374] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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13
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Tamaki M, Miura K, Norimura S, Kenzaki K, Yoshizawa K. [Acute empyema with fistula successfully treated by curettage and endobronchial Watanabe spigot (EWS)]. Kyobu Geka 2014; 67:229-232. [PMID: 24743536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A 49-year-old woman was referred to our hospital because of empyema. A chest drainage tube inserted and lavage performed. Her general condition improved but the infection and a major air leakage remained. On the 10th day after chest drainage, we performed thoracoscopic debridement and occlusion of bronchopleural fistulas using cellulose oxidized( Surgicel) and fibrin glue. Expansion of the lung and the improvement of inflammation were observed. but a major air leakage remained. On 29th postoperative day, we performed bronchial embolization using endobronchial Watanabe spigot (EWS). The leakage stopped the 7 days after bronchial embolization, we removed chest tube and 10 days after bronchial embolization she was discharged.
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Affiliation(s)
- Masafumi Tamaki
- Department of Chest Surgery, Takamatsu Red-cross Hospital, Takamatsu, Japan
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14
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Inoue M, Kinoshita K, Isogawa N, Hino N, Sano F, Kobayashi M, Yasuda S, Komatsu T, Takahashi K, Fujinaga T. [Nutritional treatment for bronchopleural fistula-promising effect of arginine as a pharmaconutrient]. Kyobu Geka 2013; 66:1137-1140. [PMID: 24322352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Pharmaconutrition, which is a supportive nutritional care of surgical patients, has been proven to shorten hospital stay, decrease the incidence of infection, and reduce hospital costs in selected groups of patients. Arginine, one of the most essential pharmaconutrients, has also been proven to enhance would healing process. In severely malnourished patients like bronchopleural fistula with resultant empyema, aggressive nutritional approach should be mandatory. And management of the fistula is also important in stabilizing the ongoing infection. Our hypothesis was that basic nutritional support enhanced with arginine would be effective in not only improving the general condition including nutritional status but also in healing the fistula. We report a case of major bronchopleural fistula in which arginine-supplemented diet as well as aggressive nutritional support could accelerate the postoperative recovery after open thoracic window, ultimately leading to the healing of the fistula.
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Affiliation(s)
- Mari Inoue
- Nutritional Support Team, Nagara Medical Center, Gifu, Japan
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15
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Schweigert M, Solymosi N, Dubecz A, Ofner D, Stein HJ. Length of nonoperative treatment and risk of pleural empyema in the management of pancreatitis-induced pancreaticopleural fistula. Am Surg 2013; 79:614-619. [PMID: 23711272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Pancreaticopleural fistula is a very uncommon complication of pancreatitis resulting from pancreatic duct disruption with leakage of pancreatic secretions into the pleural cavity. Initial conservative treatment fails in a significant number of cases. Ascending infection through the fistulous tract results in pleural empyema. The aim of this study is to investigate the relation between lengths of nonoperative management and risk of pleural empyema. The retrospective study includes our own experience as well as all case reports identified by a systematic review of the English literature from 1954 to 2012. Inclusion criteria were acute or chronic pancreatitis, whereas tumorous fistulization or complications of pancreatic surgery were kept out. A total of 113 patients were identified. There were 86 men and 27 women. The mean age was 46.5 years and 78 patients had a history of alcoholism. The mortality rate was 1.8 per cent (two of 113). Nonoperative management including interventional therapy and endoscopic stenting was successful in only 40 cases (36%), whereas 73 patients (64%) finally underwent surgery. The most common procedure was distal pancreatectomy (32 of 73). Pleural empyema occurred in 17 cases. Successful nonoperative management had a mean length of 5.5 weeks, whereas surgery was performed after an average of 10.9 weeks of failed conservative efforts. Initial nonoperative therapy was significantly longer in patients eventually sustaining empyema (17 weeks, P < 0.001) and all needed surgical intervention. Prolonged nonoperative treatment is associated with a noteworthy risk of septic complications such as pleural empyema. Further improvement seems achievable by reducing the time gap between fruitless conservative efforts and surgical intervention.
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Affiliation(s)
- Michael Schweigert
- Department of General and Thoracic Surgery, Klinikum Nuremberg Nord, Nuremberg, Germany.
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16
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Adina MM, Popovici B. Open window thoracostomy for the treatment of bronchopleural cutaneous fistula -- case report. Pneumologia 2013; 62:26-29. [PMID: 23781569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Pleural empyema and bronchopleural fistula (the communication between the pleural space and the airways) are early or late complications of various diseases. We present the case of a 29-year-old patient operated for cavitary pulmonary tuberculosis and giant caseoma at the age of seven, who also had fibrocavitary pulmonary tuberculosis positive for mycobacterium tuberculosis at the age of 19. The patient presented with low grade fever, chills, sweating, cough with mucopurulentsputum, dyspnea on mild exertion, perioral cyanosis, cyanosis of the limbs at exertion, anorexia, weight loss and skin suppuration on the left side of thorax. The diagnosis of chronic pulmonary suppuration, the failure of conservative therapy (multiple antibiotic treatments in the last three years), the presence and size of the bronchopleural cutaneous fistula, thepatient's surgical history (presence of "lifesaving"sutures), as well as his immunocompromised state required that conservative medical treatment (antibiotics, antimycotics and supportive medication for six months) be associated with surgery. An open window thoracostomy was selected over segmentectomy or lobectomy due to their associated risks caused by anatomic changes in the large vessels. The open window thoracostomy should not be forgotten or abandoned as it may be the only approach that ensures patient survival and the effective management of the residual cavity and chronicsuppuration in selected cases.
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Affiliation(s)
- Man Milena Adina
- Medicina Formoaie, Iuliu Hotieganu, Cluj-Nopoco, Catedre de Pneumologie.
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17
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Ferris H, Buckley M. Pancreatico pleural fistula: an unusual complication of chronic pancreatitis. Ir Med J 2012; 105:246-247. [PMID: 23008888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Pancreatico-pleural fistula secondary to chronic pancreatitis is a rare cause of pleural effusion. This case report presents a case of a middle aged female, a known case of chronic pancreatitis who presented with severe epigastric pain and progressive shortness of breath. CT and MRCP were useful in visualising the fistulous communication between the pancreas and pleural cavity. Treatment consisted of ERCP placement of a pancreatic stent, which facilitated internal drainage of pancreatic fluid thus resolving the pleural effusion and promoting healing of the fistula.
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Affiliation(s)
- H Ferris
- Department of Gastroenterology, Mercy University Hospital, Grenville Place, Cork.
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18
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Hamai Y, Hihara J, Emi M, Aoki Y, Miyata Y, Okada M. Airway stenting for malignant respiratory complications in esophageal cancer. Anticancer Res 2012; 32:1785-1790. [PMID: 22593462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Airway stenting is required for the palliative treatment of advanced esophageal cancer. This study retrospectively analyzes the outcomes of airway stenting for esophageal cancer at our institution. Data from nine patients who underwent airway stenting were reviewed. All patients had poor respiratory status due to esophagorespiratory fistula and/or respiratory stenosis. We retrospectively assessed the results of airway stenting as five grades of respiratory symptoms, regarding stent-related complications and clinical course and survival. Six silicone and six covered self-expandable metallic stents were deployed in five and six patients, respectively. Two types of airway stents were deployed in two patients, and double stents were positioned in the airway and in the esophagus of three other patients. The grade of respiratory symptoms improved in seven patients. The mean dyspnea grade was 3.0±0.9 and 1.3±1.3 before and after airway stenting, respectively. Stent-related complications comprised of chest pain, incomplete closure of the ERF, sputum retention and stent migration. The mean±SD survival of all patients was 103±108 (range, 0 to 325) days, and the survival of patients without relapsed cancer at the time of stenting, who underwent cancer-specific therapy after stenting, was prolonged. Although the airway should be stented according to the status and the prognosis of each patient individually stenting can relieve symptoms and improve the prognosis even when esophageal cancer is at very advanced stages. Airway stenting could play a role in the multidisciplinary management of advanced esophageal cancer.
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Affiliation(s)
- Yoichi Hamai
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
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19
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Nord GA, Rock A, Murphy FJ, Miloslavskiy I, Miller DJ, Wasserman BS. Prosthetic and surgical management of oronasal communications secondary to cocaine abuse. N Y State Dent J 2012; 78:22-25. [PMID: 22474793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Oronasal communications are serious sequelae of chronic cocaine abuse. If left untreated, these communications can severely limit a patient's quality of life. The defects can be rehabilitated successfully utilizing either maxillofacial prosthetics or various surgical techniques. Considerations in deciding between prosthetic and surgical approaches are discussed, as well as the basics of maxillofacial prosthetic rehabilitation and the different surgical techniques available. Photographic documentation of both maxillofacial prosthetic and surgical treatments performed by the authors is shown.
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Affiliation(s)
- Gary A Nord
- Wyckoff Heights Medical Center, Brooklyn, NY, USA.
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20
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Sahin-Tóth G, Farkas G, Takács T, Leindler L, Lázár G. [Current therapy of the pancreato-pleural fistula]. Magy Seb 2011; 64:301-304. [PMID: 22169344 DOI: 10.1556/maseb.64.2011.6.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This case report summarizes therapeutic options for the management of pancreato-pleural fistula (PPF) following a successful conservative treatment of one of our patients. PPF is a rare complication of chronic pancreatitis. The main aetiological factor is alcohol, which causes relapse of chronic pancreatitis associated with dyspnoea. Diagnosis is confirmed by physical examinations, laboratory tests of pleural fluid as well as ERCP being the most important diagnostic procedure. Conservative treatment of PPF consists of endoscopic therapy (endoscopic sphincterotomy with stenting of the pancreatic duct), octreotid combined with continuous enteral nutrition (jejunal feeding). If the above complex therapy fails, surgical treatment of PPF is advised.
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Chen J, Chen ZM, Pang LW, Zhu YJ, Chen G, Ma QY, Miao F. Deployment of self-expanding metallic stents under fluoroscopic guidance in patients with malignant esophagorespiratory fistula. Hepatogastroenterology 2011; 58:64-68. [PMID: 21510288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND/AIMS Stent deployment for the treatment of ERFs is typically performed under endoscopic guidance. Our aim was to evaluate self-expanding metallic stent placement under fluoroscopic guidance. METHODOLOGY The records of six patients who underwent self-expanding metallic stent placement under fluoroscopic guidance for the treatment of ERFs were reviewed. Technical data of the procedures, complications, and associated morbidity were recorded. The main outcome measures were dysphagia score, KPS, and survival. RESULTS Stents were successfully inserted in all 6 patients without complications, and all procedures were completed within 15 minutes. The mean dysphagia score was 4 +/- 0 before treatment and 1.2 +/- 0.8 one week after stent placement. The mean KPS increased significantly from 28.0 +/- 9.8 before stent placement to 58.3 +/- 16.0 one week after placement (p = 0.001). For the patients who had KPS < or =50 one week after the surgery, the survival period was relatively short (mean, 37 days). For the patients who had KPS > or =60 one week after the surgery, the mean survival period was 192 days. CONCLUSIONS Self-expanding metallic stent placement can be performed safely and quickly under fluoroscopic guidance alone.
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Affiliation(s)
- Ji Chen
- Department of Cardiothoracic Surgery, Hua Shan Hospital, Fudan University, Shang Hai, China
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22
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Andreetti C, Ibrahim M, Ciccone A, D'Andrilli A, Poggi C, Maurizi G, Pavan A, Rendina EA. Autologus platelet gel for the management of persistent alveolar fistula after lung resection. MINERVA CHIR 2010; 65:695-699. [PMID: 21224802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Postoperative alveolar fistula (AF) associated with pleural cavity (PC) is a serious complication and a therapeutic challenge in thoracic surgery. The purpose of this study was to assess the efficacy of the use of the autologous platelet gel for the treatment of AF and PC. We treated a patient with post lung resection persistent alveolar fistula using a autologous platelet gel, a cellular compose produces at the Division of Immunohaematoligy and Trasfusion. The platelet gel-PRP (Platelet-Rich Plasma) is a biological material made of autologous platelets, extracted from a small amount of the patient's blood, centrifuged at 1100 g for 9 min. The PRP obtained was activated by addition of autologous thrombin and calcium chloride to form a matrix of fibrin (PRFM) thick. The patient presented important air leak after middle lobe wedge resection for solitary lung lesion with standard open decortication for important pleural adhesions post pleuritis. On postoperative day XIII the patient developed a thoracic empyema and consequently underwent a antibiotic pleural irrigation through the chest drainage based on the microbiological analysis of the pleural fluid. After a week we obtained the resolution of the empyema but a residual space remained and air leak persisted. We treated the patient with autologous platelet gel. We administer 7.5 mL of the autologous platelet gel across the chest drainage ever 72 hours for 3 times. After the third application we had the closure of the cavity and the cessation of air leak. Autologous platelet gel is easy to use, safe and inexpensive. It can be considered a valid therapeutic option in selected patients with a alveolar fistula and a lung partial re-expansion. The product consist of a significant amount of cellular components with healing anti-inflammatory an proregenerative properities that permit the body to heal tissue wounds faster and more efficiently. A sterile pleural cavity is fundamental conditions for the final success of the procedure.
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Affiliation(s)
- C Andreetti
- Department of Thoracic Surgery, La Sapienza, University of Rome, Sant'Andrea Hospital, Rome, Italy.
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Umehara S, Fujiwara H, Shiozaki A, Komatsu S, Ichikawa D, Okamoto K, Murayama Y, Kuriu Y, Ikoma H, Nakanishi M, Ochiai T, Kokuba Y, Sonoyama T, Otsuji E. [Usefulness of esophageal stenting by using a covered self-expandable metallic stent for esophagorespiratory fistula associated with esophageal carcinoma]. Gan To Kagaku Ryoho 2010; 37:2391-2393. [PMID: 21224583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
We report three cases of esophagorespiratory fistula associated with esophageal carcinoma successfully treated with esophageal stenting by using a covered self-expandable metallic stent (SEMS). All three cases had advanced esophageal carcinoma at middle thoracic esophagus with esophagorespiratory fistula at the level of esophageal carcinoma. Case 1 is a 58-year-old man who had lung abscess due to esophagopulmonary fistula caused after induction chemoradiotherapy. He underwent a surgical resection of the affected lung and intraoperative esophageal stenting with dietary intake starting on day 26 after stenting. Case 2 is a 60-year-old man with esophagopulmonary fistula caused after primary chemotherapy. He started to take an oral intake on day 3 after esophageal stenting. Case 3 is a 68-year-old man with esophagobronchial fistula detected at the first medical examination. He started to take an oral diet on day 7 after esophageal stenting. All three cases had a rapid improvement of respiratory symptoms, pneumonia and malnutrition by esophageal stenting leading to marked improvement of impaired general condition. Esophageal stenting is a useful method for palliation of esophageal carcinoma with respiratory fistula.
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Affiliation(s)
- Seiji Umehara
- Division of Digestive Surgery, Dept. of Surgery, Kyoto Prefectural University of Medicine
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Gogia P, Gupta S, Goyal R. Bronchoscopic management of bronchopleural fistula. Indian J Chest Dis Allied Sci 2010; 52:161-163. [PMID: 20949736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
In recent years successful bronchoscopic management of bronchopleural fistulas (BPFs) by locating its site and then blocking the leaking segment with any of the several agents available has gained recognition. It is now considered as an alternate mode of management of BPF. Here we present a case of non-resolving pneumothorax that was managed successfully using bronchoscopic glue (cyanoacrylate glue) instillation.
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Affiliation(s)
- P Gogia
- Centre for Respiratory Diseases and Critical Care, Jaipur Golden Hospital, Rohini, New Delhi, India.
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25
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Ko HS, Han KY, Kim JH, Kim JY, Shim BS, Song YJ. Spontaneous cervical emphysema with nasopharyngeal fistula. Arch Otolaryngol Head Neck Surg 2010; 136:404-406. [PMID: 20403859 DOI: 10.1001/archoto.2010.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Han Sung Ko
- Department of Otolaryngology-Head and Neck Surgery, Ulsan University College of Medicine, Gangneung Asan Hospital, Gangneung, South Korea
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Lacroix G, Meaudre E, Prunet B, Bordes J, Allanic L, Kaiser E. [One case report of tracheo-innominate artery fistula responsible of massive haemoptysis in a tracheotomized patient: which strategy to adopt?]. ACTA ACUST UNITED AC 2009; 28:980-2. [PMID: 19939619 DOI: 10.1016/j.annfar.2009.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2009] [Accepted: 10/01/2009] [Indexed: 11/30/2022]
Abstract
The tracheo-innominate artery fistula is a rare but life-threatening complication of the tracheotomy. Its care management requires a rapid airway control to allow haemostasis by compression and ventilation. The haemostasis must be immediate and two techniques exist: surgery opencast (sternotomy) or interventional radiology. The choice between the two depends largely on the technical platform available. Our case report describes a tracheo-innomninate artery fistula surgically managed with success. The patient carried an anatomic variant, the two carotids come from innominate artery.
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Affiliation(s)
- G Lacroix
- Département d'anesthésie-réanimation-urgences, hôpital d'instruction des Armées-Sainte-Anne, boulevard Sainte-Anne, 83000 Toulon, France.
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27
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Prodromos P, Condilis N. Thoracobiliary fistula. A rare complication of thoracoabdominal trauma. Ann Ital Chir 2009; 80:467-470. [PMID: 20476681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Thoracobiliary fistulas (bronchobiliary and pleurobiliary) are rare complications of thoracoabdominal trauma. Owing to their rarity, there is little consensus on the optimal management . The diagnostic suspicion however must be considered and it's important the correct selection of diagnostic imaging techniques. Biliptysis is the pathognomonic physical finding of bronchobiliary fistulas. Demonstration of high bilirubin levels in the pleural effusion is diagnostic for a pleuro-biliary fistula. The optimal treatment of bronchobiliary fistulas is operative, in order to prevent their dramatic consequences. For pleurobiliary fistulas, a light aggressive conservative approach is an appealing option in the beginning. Newer endoscopic techniques increase the non-operative approach.
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Affiliation(s)
- Philippou Prodromos
- Department of General Surgery, Nicosia General Hospital, Nicosia, Cyprus, Greece
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28
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Miyauchi A, Inoue H, Tomoda C, Amino N. Evaluation of chemocauterization treatment for obliteration of pyriform sinus fistula as a route of infection causing acute suppurative thyroiditis. Thyroid 2009; 19:789-93. [PMID: 19508119 DOI: 10.1089/thy.2009.0015] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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29
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Osaki T, Matsuura H. Thoracic empyema and lung abscess resulting from gastropulmonary fistula as a complication of esophagectomy. Ann Thorac Cardiovasc Surg 2008; 14:172-174. [PMID: 18577896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2007] [Accepted: 06/04/2007] [Indexed: 05/26/2023] Open
Abstract
A benign fistula between the gastric tube and the airway resulting from esophagectomy is a rare complication, but it is a potentially life-threatening status. We present a 59-year-old man with thoracic empyema and lung abscess resulting from a benign gastric tube-to-pulmonary fistula caused by a penetration of the peptic ulcer in the gastric tube four years after an esophagectomy for esophageal cancer. After a thorough conservative management of infection and nutrition, the fistula was successfully repaired surgically with direct closure. The postoperative course was uneventful. Two years and nine months later, the patient retains satisfactory oral feeding status and is in good general condition.
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Affiliation(s)
- Toshihiro Osaki
- Department of Chest Surgery, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
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30
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Antonaglia V, Lucangelo U, Zin WA. Prone position to treat bronchopleural fistula in post-operative acute lung injury. J Clin Monit Comput 2007; 21:317-21. [PMID: 17701077 DOI: 10.1007/s10877-007-9090-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2007] [Accepted: 07/18/2007] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Prone position is used to treat patients with acute lung injury or acute respiratory distress syndrome because it improves gas exchange and respiratory mechanics. When broncho-pleural fistula occurring, the clinical impact of prone position is limited; however, its use could be tried when the fistula is small or other potential treatments are not possible. METHODS A 45-year-old man with oesophageal cancer submitted to a total oesophagectomy with intrathoracic transposition of the stomach developed post-operatively respiratory failure and pneumothorax, which were worsened by unilateral pleural rupture and severe subcutaneous emphysema produced after an attempt to introduce through anterior chest wall a second drainage tube. RESULTS Prone position associated with lung protective strategy was implemented during 16-18 h daily and after the change of position PaO2/FiO2 increased of 35% and PaCO2-PetCO2 decreased about 40%; at 4th day under treatment, the subcutaneous emphysema and pneumothorax could not be detected either clinically or radiologically. On the 6th day the lung lesion could not be observed under the CT-scan. CONCLUSIONS In a patient that underwent a major thoracic surgery the addition of prone positioning to protective lung ventilation rendered possible not only the healing of the acute lung injury, but also the quick repair of a lung rupture owing to a thoracic drainage attempt.
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31
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Haddad R, de Carvalho Junior A. Innominate vein-pleural fistula after left jugular vein catheterization treated with endovascular procedure. Eur J Cardiothorac Surg 2007; 32:534. [PMID: 17627830 DOI: 10.1016/j.ejcts.2007.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2007] [Revised: 04/22/2007] [Accepted: 06/04/2007] [Indexed: 11/28/2022] Open
Affiliation(s)
- Rui Haddad
- Department of Surgery, Thoracic Surgery, Faculty of Medicine, Federal University of Rio de Janeiro, and Department of Radiology, Hospital Samaritano, Rio de Janeiro, RJ, Brazil.
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32
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Abstract
OBJECTIVE To report a pediatric case of subarachnoid-pleural fistula, its diagnosis, and its treatment. DESIGN Case report. SETTING Pediatric intensive care unit. PATIENT A 9-month-old boy, presenting with severe pleural effusion after posterior chest wall surgery. INTERVENTIONS Subarachnoid-pleural fistula was confirmed by isolating beta2-transferrin in the pleural fluid and with magnetic resonance cisternography revealing the location. The patient had a healthy outcome, and the fistula dried without surgery, using positive-pressure ventilation and a chest drain. CONCLUSIONS We used beta2-transferrin to confirm the diagnosis of clinically suspected subarachnoid-pleural fistula. High-resolution computed tomographic and magnetic resonance cisternography are the best techniques to localize the fistula. The currently recommended treatment is surgery; we suggest that bilevel positive-pressure ventilation, especially with noninvasive techniques, could be a treatment alternative, reducing the flow of cerebral spinal fluid through the fistula and allowing spontaneous closure.
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Affiliation(s)
- Frédéric V Valla
- Pediatric Intensive Care Unit, Debrousse Pediatric University Hospital, Lyon, France.
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33
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Sivrikoz CM, Kaya T, Tulay CM, Ak I, Bilir A, Döner E. Effective approach for the treatment of bronchopleural fistula: application of endovascular metallic ring-shaped coil in combination with fibrin glue. Ann Thorac Surg 2007; 83:2199-201. [PMID: 17532426 DOI: 10.1016/j.athoracsur.2007.01.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2006] [Revised: 12/25/2006] [Accepted: 01/08/2007] [Indexed: 10/23/2022]
Abstract
The development of bronchopleural fistula is an important complication after pulmonary resections. Generally, conventional treatment methods are used in patients having bronchopleural fistulas. Recently, there has been an increase in the use of minimally invasive methods yielding better results. In our study, we applied a combination of endovascular metallic ring coil and fibrin glue. We hereby think that such an approach for a combination might be a contribution to improving the already existing minimally invasive treatment methods.
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Affiliation(s)
- Cumhur M Sivrikoz
- Department of Thoracic Surgery, Eskişehir Osmangazi University Faculty of Medicine, Osmangazi University Medical School, Eskişehir, Turkey.
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34
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Boudaya MS, Alifano M, Baccari S, Regnard JF. Hemothorax as the clinical presentation of a pancreaticopleural fistula: report of a case. Surg Today 2007; 37:518-20. [PMID: 17522775 DOI: 10.1007/s00595-006-3427-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2006] [Accepted: 10/31/2006] [Indexed: 10/23/2022]
Abstract
Pancreaticopleural fistula is a rare complication of acute pancreatitis with pancreatic pseudocyst. We report the case of a 39-year-old man admitted for respiratory distress. Chest X-ray showed a pleural effusion, and thoracentesis yielded bloody fluid. Computed tomography (CT) scan showed a multiloculated pleural effusion and sagittal reconstruction revealed a fistulous tract between the pleura and a pancreatic pseudocyst. We treated the acute hemothorax complicating the pancreaticopleural fistula by performing urgent thoracotomy with the evacuation of blood and clots and lung decortication. We also gave the patient somatostatin and performed endoscopic retrograde cholangiopancreatography with sphincterotomy, and placed a pancreatic stent. The patient recovered well.
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Affiliation(s)
- Mohamed Sadok Boudaya
- Unité de Chirurgie Thoracique, Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris, Université Paris V, Paris, 1 place du Parvis Notre Dame, 75181, Paris, Cedex 04, France
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35
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Abstract
Pulmonary arteriovenous malformations are rare anomalies that carry a considerable risk of serious complications such as cerebral thromboembolism or abscess and pulmonary hemorrhage. The first-line treatment of such malformations is detachable coil or balloon embolotherapy. However, coils and balloons may migrate and cause paradoxical embolism especially in malformations with large arteriovenous shunts. We report a case in which we used a new vascular occlusion device (amplatzer vascular plug), to occlude a pulmonary arteriovenous fistula in a patient with Rendu-Osler-Weber syndrome.
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Affiliation(s)
- Sebastián Baldi
- Servicio de Diagnóstico y Terapéutica Endoluminal, Hospital Hospiten Rambla, Santa Cruz de Tenerife, Spain.
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36
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Jakubec P, Kolek V, Procházka V, Konecný M, Jakubcová T. [Pancreaticopleural fistula]. Vnitr Lek 2007; 53:135-42. [PMID: 17419174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Pancreatic diseases are often accompanied by pleuropulmonal complications. Acute pancreatitis may induce a number of various pathological findings in respiratory tract including hypoxemia, decrease of transfer-factor (DLCO), decrease of transfer-coefficient (DLCO/VO), decrease in forced expiratory flow 25%- 75% of forced vital capacity (FEF25-75%), elevated and/or immobile diaphragm, basal atelectasis, unilateral or bilateral pulmonary infiltrations, mediastinal pseudocyst and pleural effusion. Acute respiratory distress syndrome (ARDS) is the most dangerous complication of acute pancreatitis. Large, recurrent pleural effusion is sometimes present in chronic pancreatitis, typically with a very high concentration of amylase in pleural fluid. Pancreaticopleural fistula (PPF) is the most common cause of this type of pleural effusion. We describe a study group of 3 patients with PPF and pleural effusion, their clinical symptoms, diagnostics and management.
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Affiliation(s)
- P Jakubec
- Klinika plicních nemocí a tuberkulózy Lékarské fakulty UP a FN Olomouc.
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Mora G, de Pablo A, García-Gallo CL, Laporta R, Ussetti P, Gámez P, Córdoba M, Varela A, Ferreiro MJ. [Is endoscopic treatment of bronchopleural fistula useful?]. Arch Bronconeumol 2007; 42:394-8. [PMID: 16948992 DOI: 10.1016/s1579-2129(06)60553-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE New endoscopic techniques have been developed as an alternative to surgical treatment of bronchopleural fistula. The objective of this study was to analyze our experience with endoscopic treatment of such fistulas. MATERIAL AND METHODS We conducted a retrospective study of patients with bronchopleural fistula diagnosed by fiberoptic bronchoscopy. Patient characteristics, underlying disease, fistula size, and outcome of endoscopic treatment were analyzed. The endoscopic technique consisted of injection of fibrin sealants (Histoacryl and/or Tissucol) through the catheter of the fiberoptic bronchoscope. RESULTS Between 1997 and 2004, 18 patients were diagnosed with bronchopleural fistula by fiberoptic bronchoscopy. All were men with a mean (SD) age of 62 (12) years. Bronchopleural fistula was diagnosed after neoplastic surgery in 16 patients, in the bronchial suture after lung transplantation in 1 patient, and concurrently with pleural effusion due to hydatidosis in the remaining patient. The size of the fistula ranged from 1 mm to 10 mm (mean 3.6 [2.7] mm). Fibrin sealants were applied in 14 patients, 2 underwent direct surgery after diagnosis, and the bronchopleural fistula closed spontaneously in the remaining 2. The fibrin sealant used was Histoacryl in 12 patients and Tissucol in 2. Pleural drainage was employed simultaneously and antibiotic therapy was administered at the discretion of the surgeon. The 4 patients whose bronchopleural fistula was associated with empyema also underwent pleural lavage. In 12 patients the fistulas closed as a result of the endoscopic technique (85.7%), and no complications were observed. For 85.7%, fewer than 3 applications of fibrin sealant were necessary. CONCLUSIONS The success rate of closure of bronchopleural fistula with fibrin sealants injected under guidance with fiberoptic bronchoscopy is high and there are no complications. This technique can render surgery unnecessary.
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Affiliation(s)
- Gemma Mora
- Servicio de Neumología, Hospital Universitario Puerta de Hierro, Madrid, España.
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38
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Lang-Lazdunski L. Closure of a bronchopleural fistula after extended right pneumonectomy after induction chemotherapy with BioGlue surgical adhesive. J Thorac Cardiovasc Surg 2006; 132:1497-8. [PMID: 17140997 DOI: 10.1016/j.jtcvs.2006.08.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2006] [Accepted: 08/08/2006] [Indexed: 11/22/2022]
Affiliation(s)
- Loïc Lang-Lazdunski
- Department of Thoracic Surgery, Guy's Hospital and King's College, London, United Kingdom.
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39
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Abstract
The purpose of this report is to describe our experience in the successful treatment of two patients with postpneumonectomy bronchopleural fistula (BPF). With use of computed tomography reformatting, the stent-graft occluders were tailored to precisely fit the fistula site and remnant bronchus stump. These were placed under fluoroscopic guidance via a preexisting chest tube tract in one case and via an open thoracostomy window site in the other. The BPFs were successfully occluded without complications, and the stent-graft occluders remained stable in position for 1 year and 6 months of follow-up, respectively.
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Affiliation(s)
- Ki-Hong Kim
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, 134 Shinchon-dong, Seodaemun-gu, Seoul 120-752, Republic of Korea
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40
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Ordulu M, Emes Y, Ates M, Aktas I, Yalçin S. Oronasal communication caused by a denture with suction cup: a case report. Quintessence Int 2006; 37:659-62. [PMID: 16922027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Suction cups, which provide high retention, are not being recommended anymore because of the destructive effect of the negative pressure on the palatal tissues. It is known that dentures with suction cups can cause perforations in the palate. In this case report, an oronasal communication caused by a denture with suction cup in a patient who had previously undergone pleomorphic adenoma excision of the palate is presented. Disadvantages of suction cups are emphasized.
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Affiliation(s)
- Melike Ordulu
- Department of Oral and Maxillofacial Surgery, Istanbul University, Faculty of Dentistry, Istanbul, Turkey
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41
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Koshitani T, Uehara Y, Yasu T, Yamashita Y, Kirishima T, Yoshinami N, Takaaki J, Shintani H, Kashima K, Ogasawara H, Katsuma Y, Okanoue T. Endoscopic management of pancreaticopleural fistulas: a report of three patients. Endoscopy 2006; 38:749-51. [PMID: 16586252 DOI: 10.1055/s-2006-925062] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Pancreaticopleural fistulas are a rare complication of acute or chronic pancreatitis, and are usually treated by surgery. We report three patients whose pancreaticopleural fistulas were successfully treated by endoscopic retrograde cholangiopancreatography and drainage (stenting, nasopancreatic drainage). In one patient a pancreatic pseudocyst persisted despite successful initial closure of the leak using this method and, as it was also suspected to be infected, additional drainage of the pseudocyst was required. Endotherapy of pancreaticopleural fistulas could obviate the need for surgery when conventional medical treatment has failed in this condition.
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Affiliation(s)
- T Koshitani
- Department of Gastroenterology, Kyoto City Hospital, Kyoto, Japan.
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Yim APC. Invited commentary. Ann Thorac Surg 2006; 81:1871. [PMID: 16631689 DOI: 10.1016/j.athoracsur.2006.01.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2006] [Revised: 01/04/2006] [Accepted: 01/13/2006] [Indexed: 10/24/2022]
Affiliation(s)
- Anthony P C Yim
- Division of Cardiothoracic Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital Shatin, N.T., Hong Kong.
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Han X, Wu G, Li Y, Li M. A Novel Approach: Treatment of Bronchial Stump Fistula With a Plugged, Bullet-Shaped, Angled Stent. Ann Thorac Surg 2006; 81:1867-71. [PMID: 16631688 DOI: 10.1016/j.athoracsur.2005.12.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2005] [Revised: 12/01/2005] [Accepted: 12/02/2005] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the initial clinical efficacy of a plugged, bullet-shaped, angled stent for managing bronchial stump fistula. DESCRIPTION The stent consisted of two parts. The body part had a diameter of 18 approximately 25 mm and was 30 mm long in a tubular configuration covered with polyethylene at the lower part. The bronchial limb was a bullet-shaped configuration with a dead end, 11 approximately 14 mm in diameter, 10 approximately 30 mm long covered with polyethylene. The body part and the bronchial limb were connected at the angled portion without overlap with use of nitinol wire and polyethylene. The stents were placed in 6 patients under fluoroscopic guidance. EVALUATION Stent placement was technically successful in all patients without complications. Immediate closure of the bronchial stump fistula was achieved in all patients after stent placement. Follow-up of 4 approximately 16 months, permanent closure of the bronchial pleural fistula was achieved in 4 patients (66.67%), and permanent closure of the bronchial stump fistula was achieved in 5 patients (83.33%). No complications occurred. CONCLUSIONS Closure of the bronchial stump fistula with the stent was a simple, safe, and effective procedure.
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Affiliation(s)
- Xinwei Han
- Department of Radiology, The First Affiliated Hospital, Zheng Zhou, China.
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Ben Soussan E, Antonietti M, Lecleire S, Savoye G, Di Fiore F, Paillot B, Michel P, Ducrotté P, Lerebours E. Palliative esophageal stent placement using endoscopic guidance without fluoroscopy. ACTA ACUST UNITED AC 2005; 29:785-8. [PMID: 16294146 DOI: 10.1016/s0399-8320(05)86348-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIMS Fluoroscopy is not available in every endoscopic unit. This situation leads to delays in treatment or to transfer of patients to other centres for stent insertion. We assessed safety and effectiveness of expandable esophageal metal stent placement under endoscopic control without fluoroscopy using a thin gastroscope. PATIENTS AND METHODS From October 2002 to June 2004, thirty-three consecutive patients have been included for esophageal stent placement under endoscopic control alone with a nasogastroscope (5.9 mm). A proximal release covered stent (Ultraflex; Boston Scientific Microvasive) was used. Indications were malignant esophageal stricture (N = 26), malignant extrinsic compression (N = 2 ) and esophago-respiratory neoplastic fistulae (N = 5). RESULTS Stent placement using endoscopic control alone was successful in 30/33 (90%) patients. Complications occurred in 11 patients. Early complications (<7 days) included one death from pulmonary embolism, severe retrosternal pain needing transient morphinic treatment (N = 2) and GERD despite antisecretory therapy (N = 1). Late complications included: food impaction (N = 1), tumour overgrowth-related obstruction of the stent (N = 5) and one late esophago-respiratory fistula at 4 months at the proximal end of the stent. Relief of dysphagia was obtained for all patients at 48 hours and dysphagia score decreased from 3.1 before stent to 1.2 at 1 month (P < 0.05). CONCLUSION Expandable esophageal stents can be accurately and safely placed using endoscopy with a thin gastrosocope. This method obviates the requirement of fluoroscopic access, lacking in many centres, and avoids exposure to X-ray.
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Affiliation(s)
- Emmanuel Ben Soussan
- Digestive Tract Research Group, Rouen University hospital Charles Nicolle, 76031 Rouen Cedex.
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Grant CA, Dempsey G, Harrison J, Jones T. Tracheo-innominate artery fistula after percutaneous tracheostomy: three case reports and a clinical review. Br J Anaesth 2005; 96:127-31. [PMID: 16299043 DOI: 10.1093/bja/aei282] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Tracheo-innominate artery fistula (TIF) is an uncommon yet life threatening complication after a tracheostomy. Rates of 0.1-1% after surgical tracheostomy have been reported, with a peak incidence at 7-14 days post procedure. It is usually fatal unless treatment is instituted immediately. Initial case reports of TIF resulted from surgically performed tracheostomies. We present three fatalities attributable to TIF, confirmed by histopathology, after percutaneous dilatational tracheostomy (PDT). The use of PDT has resulted in tracheostomies being performed by specialists from different backgrounds and the incidence of this complication may be increasing. Pressure necrosis from high cuff pressure, mucosal trauma from malpositioned cannula tip, low tracheal incision, radiotherapy and prolonged intubation are all implicated in TIF formation. Massive haemorrhage occurring 3 days to 6 weeks after tracheostomy is a result of TIF until proven otherwise. We present a simple algorithm for management of this situation. The manoeuvres outlined will control bleeding in more than 80% of patients by a direct tamponade effect. Surgical stasis is obtained by debriding the innominate artery proximally, then transecting and closing the lumen. Neurological sequelae are few. Post-mortem diagnosis of TIF may be difficult, but specific pathology request should be made to assess innominate artery abnormalities.
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Affiliation(s)
- C A Grant
- Critical Care Unit, University Hospital, Aintree, Liverpool, UK.
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Abstract
Syphilis and cocaine abuse are posing a growing public health problem on a global and national scale. Clinicians are increasingly likely to come across associated oral manifestations. We present two cases of palatal perforations caused by tertiary syphilis and cocaine abuse respectively. The literature review discusses issues specific to palatal perforations and those general to both conditions. The purpose of the report is to focus attention on syphilis and cocaine abuse as rising problems for the dental profession.
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Affiliation(s)
- M K Bains
- Orpington Hospital, Oral & Maxillofacial Surgery, Orpington, Kent, BR6 9JU.
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Abstract
PURPOSE OF REVIEW Alveolar-pleural fistulas (air leaks) are an extremely common clinical problem and remain the most common complication after elective pulmonary resection and video-assisted procedures. The decision making process used to manage air leaks and chest tubes that control them has been, until very recently, based on opinions and training preferences as opposed to facts derived from randomized clinical trials. RECENT FINDINGS Recently, several prospective randomized trials have studied air leaks. An objective, reproducible classification system has also been designed and clinically validated to help study air leaks. This system and these studies have shown that water seal is superior to wall suction to help stop most leaks. Even in patients with a pneumothorax and an air leak, water seal is safe and best; however, if a patient has a large leak (greater than an expiratory 3 on the classification system) or experiences subcutaneous emphysema or an expanding pneumothorax that causes hypoxia, then some suction (-10 cm of water) should be applied to the chest tubes. SUMMARY Air leaks were a poorly understood yet extremely common clinical problem that had never been scientifically studied. Over the past 5 years, prospective randomized studies have shown that water seal is the best setting for chest tubes and that a pneumothorax is not a contraindication to leaving tubes on seal. Further studies are needed to investigate the ideal management of alveolar-pleural fistulas (air leaks) in different clinical scenarios besides those that occur postoperatively.
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Spidlen V, Vodicka J, Brůha F, Chudácek Z. [A postoperative bronchopleural fistule--a success of the conservative treatment (a case review)]. Rozhl Chir 2005; 84:346-9. [PMID: 16164083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Disintegration of the bronchial stub following the lung resection procedures together with development of the bronchopleural fistule and the postoperative empyema of the thorax, remain a feared complication following all lung resections, but especially pneumonectomies. In this case review, the authors report on a successful conservative management case, which followed an unsuccessful surgical revision and an attempt for the endobronchial stent introduction. 20 months following the closure of the fistule, the patient shows no signs of a relapse of the disorder.
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Affiliation(s)
- V Spidlen
- Chirurgická klinika Fakultní nemocnice v Plzni.
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Abstract
OBJECTIVE Thoracobiliary fistula, subsequent to a combined thoracic and hepatic blunt trauma, is a rare complication, which calls for a high index of suspicion during diagnostic workup. Due to its uncommon nature, especially in children, and hence the paucity of reports in literature, no consensus has been reached on its optimal management. PATIENTS AND METHODS We report on a 4-yr-old girl, who developed a cholothorax after a blunt thoracoabdominal trauma. She was successfully treated through conservative management with drainage, antibiotics, and a low-fat diet. The cases previously described in the English literature are reviewed, and management is discussed. CONCLUSION The recent tendency to observe rather than explore abdominal trauma and the absence of a definitive diagnostic test for diaphragmatic injury may contribute to a delayed diagnosis of the components that may result in the development of a fistula. Literature review substantiates endoscopic retrograde cholangiopancreatography as the imaging modality of choice, because it has the potential of therapeutic intervention by sphincterotomy or stent placement. A nonoperative approach was successful in this case.
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Affiliation(s)
- Anke Waelbers
- Paediatric Intensive Care Unit, and the Department of Paediatric Surgery, Queen Paola Children's Hospital, Lindendreef 11, Antwerp, Belgium
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Dhebri AR, Ferran N. Nonsurgical management of pancreaticopleural fistula. JOP 2005; 6:152-61. [PMID: 15767731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
CONTEXT Pancreaticopleural fistula is seen in acute and chronic pancreatitis or after traumatic or surgical disruption of the pancreatic duct. Surgery leads to healing in 80-90% of cases but carries a mortality of up to 10%. AIM Our aim was to assess the management of pancreaticopleural fistula on a specialist pancreatic Unit. METHODS Patients presenting with pancreaticopleural fistulae were identified from acute and chronic pancreatitis databases. Management and outcome were compared with previous studies identified in MEDLINE and EMBASE. RESULTS Four patients presented with dyspnoea from large unilateral pleural effusions. Three had a history of alcohol abuse and one of asymptomatic gallstones. All were treated with chest drainage, octreotide and endoscopic retrograde cholangiopancreatography plus/minus pancreatic stent. Two had a pancreatic stent in situ for 5 and 8.5 months respectively. In the third sphincterotomy was performed; in the fourth the pancreatic duct could not be cannulated. The fistula healed in all cases, with no recurrence after 12-30 months, and no deaths. There are 14 reports including 16 cases treated with endoscopic retrograde cholangiopancreatography plus/minus pancreatic stent in the literature, with no recurrence after follow up ranging 4-30 months and no deaths in these 16 cases. CONCLUSIONS A high index of suspicion is necessary to be aware of its presence. These data suggest that endoscopic management is preferable alternative to surgery for pancreaticopleural fistula.
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Affiliation(s)
- Alhad R Dhebri
- Department of Surgery, 3rd Floor, Linda McCartney Centre, Royal Liverpool University Hospital, Liverpool, United Kingdom.
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