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Chen J. Vascular covered stent and video-assisted thoracoscopic surgery for Aortoesophageal fistula caused by esophageal fishbone: a case report. J Cardiothorac Surg 2024; 19:112. [PMID: 38461352 PMCID: PMC10924337 DOI: 10.1186/s13019-024-02610-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 07/26/2023] [Accepted: 03/05/2024] [Indexed: 03/11/2024] Open
Abstract
BACKGROUND Aortoesophageal fistula (AEF) is a rare condition characterized by communication between the aorta and esophagus. AEF caused by an esophageal foreign body is even rare, and there is currently no recommended standard treatment protocol. We report a case of delayed aortic rupture after the endoscopic removal of a fish bone, which was successfully treated with a combined approach of vascular stenting and thoracic surgery. CASE PRESENTATION A 33-year-old man presented to the hospital after experiencing chest discomfort for 3 days following the accidental ingestion of a fish bone. Under endoscopic guidance, the fish bone was successfully removed, and the patient was subsequently admitted for medical therapy. On the fourth postoperative day, the patient suddenly developed hematemesis, and chest computed tomography angiography revealed the presence of an AEF. This necessitated urgent intervention; hence, thoracic surgery was performed and a vascular-covered stent was placed. Following the surgical procedure, the patient received active medical treatment, recovered well, and was successfully discharged from the hospital. CONCLUSIONS In patients with esophageal perforation caused by foreign bodies, hospitalization for observation, computed tomography angiography examination, early use of antibiotics, and careful assessment of aortic damage are advised. Thoracic endovascular aortic repair and esophageal rupture repair may have benefits for the treatment of AEF.
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Affiliation(s)
- Jianfeng Chen
- Department of Anesthesiology, West China Hospital, Sichuan University, No 37 Guoxue Alley, Wuhou District, Chengdu City, Sichuan Province, PR China.
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2
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Keh RYS, du Plessis D, Potter GM, Kobylecki C, Cooper P. Fatal cerebral air embolism from atrio-oesophageal fistula following cardiac ablation. Pract Neurol 2024; 24:37-40. [PMID: 37827844 DOI: 10.1136/pn-2023-003915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Accepted: 09/10/2023] [Indexed: 10/14/2023]
Abstract
A young woman with Rogers syndrome (thiamine-responsive megaloblastic anaemia, diabetes mellitus and sensorineural deafness) presented with headache, recurrent supraventricular tachycardia and features of an upper gastrointestinal bleed, 1 month after radiofrequency cardiac ablation for supraventricular tachycardia. She deteriorated rapidly after endoscopy and subsequently died. Brain imaging during the acute deterioration showed diffuse intracranial air embolism and hypoxic-ischaemic injury. Postmortem examination showed an atrio-oesophageal fistula, a rare complication of cardiac ablation. Clinicians should suspect this condition in patients with acute neurological deterioration after cardiac ablation who have diffuse air embolism on imaging.
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Affiliation(s)
- Ryan Yann Shern Keh
- Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, UK
- MRC Centre for Neuromuscular Diseases, National Hospital of Neurology and Neurosurgery, Queen Square, University College London Hospitals NHS Foundation Trust, London, UK
| | - Daniel du Plessis
- Department of Neuropathology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, UK
| | - Gillian M Potter
- Department of Neuroradiology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, UK
- University of Manchester, Manchester, UK
| | - Christopher Kobylecki
- Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, UK
- University of Manchester, Manchester, UK
| | - Paul Cooper
- Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, UK
- University of Manchester, Manchester, UK
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3
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Lee YP, Ozaki K, Oshima S, Hirokami T. Aortoesophageal fistula treated using one-stage total reconstruction: a case report from a high-volume center. J Cardiothorac Surg 2023; 18:329. [PMID: 37964318 PMCID: PMC10647152 DOI: 10.1186/s13019-023-02438-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 03/13/2023] [Accepted: 11/04/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Aortoesophageal fistula (AEF) is a rare but typically life-threatening condition. Although several treatment strategies exist, including conservative treatment with intraluminal stent graft and open thoracic aortic replacement, the overall outcome remains poor, ranging from 16 to 39%. Furthermore, esophageal reconstruction methods vary between hospitals. Herein, we report a case of aortoesophageal fistula treated using one-stage total reconstruction. CASE PRESENTATION This case involved a 58-year-old woman who developed acute type A aortic dissection and underwent successful total arch replacement at the other hospital. However, she developed AEF 1 year later and underwent urgent thoracic endovascular aortic repair, which eventually failed. We performed thoracic aortic replacement, total esophagectomy, gastric tube reconstruction, and omental flap in a one-stage operation. The patient was extubated the next day and transferred to the general ward on postoperative day 3. Computed tomography revealed favorable results. CONCLUSIONS For postoperative AEF, dedicated debridement with reconstruction is more effective than conservative treatment. In an experienced center, post-procedure-related AEF can be easily treated using one-stage reconstruction.
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Affiliation(s)
- Yi-Ping Lee
- Kawasaki Aortic Center, Kawasaki Saiwai Hospital, Kawasaki, Japan.
- Division of Thoracic and Cardiovascular Surgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
| | - Kensuke Ozaki
- Kawasaki Aortic Center, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Susumu Oshima
- Kawasaki Aortic Center, Kawasaki Saiwai Hospital, Kawasaki, Japan
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Odera A, Peer N, Balakrishna Y, Sheik Gafoor MH. Management and Outcomes of Esophageal Atresia With or Without Tracheo-Esophageal Fistula Over 15 Years in South Africa. J Surg Res 2023; 291:442-451. [PMID: 37517352 DOI: 10.1016/j.jss.2023.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 02/27/2023] [Revised: 06/05/2023] [Accepted: 06/25/2023] [Indexed: 08/01/2023]
Abstract
INTRODUCTION To determine the incidence, management and outcomes of esophageal atresia/tracheo-esophageal fistula (EA/TEF) over a 15-y period in South Africa. METHODS A retrospective chart review of neonates with EA/TEF presenting at the main tertiary referral hospital in the KwaZulu-Natal province between 2002 and 2017 was conducted. Data collection comprised patient and maternal demographics, clinical presentations, laboratory and radiologic investigations, surgical procedures, and outcomes. A multivariate logistic regression determined the risk factors associated with mortality. RESULTS Among 180 neonates, mean (SD) age of diagnosis was four (three) days postnatal with Gross Type C (n = 165, 92%) being the most common and the incidence was one per 10,000 live births. Majority were born term (n = 95, 53%) at peripheral hospitals (n = 167, 93%) with a mean birth weight of 2369 (736) grams. Overall HIV exposure rate was 27% (n = 48). Most (n = 138, 77%) patients presented with established pneumonia, 44% (n = 61) of whom required prolonged (>7 d) ventilator support. The median (IQR) hospital stay was 11 (8-20) d. Overall survival rate was 70% (n = 126). Birth weight <1500 g, life threatening anomalies, ventilation >30 d and postoperative sepsis contributed to mortality. CONCLUSIONS Incidence, disease types and presentations were similar to developed countries. Despite advances in technology and neonatal care in Africa, EA/TEF surgical outcomes remain suboptimal likely due to caregivers' inability to care for these infants in disadvantaged socioeconomic circumstances with poor sanitation, etc. Research is needed to identify strategies tailored for disadvantaged communities which may contribute to improved outcomes in the perioperative and postoperative period.
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Affiliation(s)
- Agneta Odera
- Department of Paediatric Surgery, Inkosi Albert Luthuli Central Hospital, and Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Mayville, Durban, South Africa
| | - Nasheeta Peer
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Overport, Durban, South Africa.
| | - Yusentha Balakrishna
- Biostatistics Research Unit, South African Medical Research Council, Overport, Durban, South Africa
| | - Mahomed Hoosen Sheik Gafoor
- Department of Paediatric Surgery, Inkosi Albert Luthuli Central Hospital, and Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Mayville, Durban, South Africa
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5
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Seal KS, Abu-Halimah SJ, Dyer BW, Tobin EC, Jadue-Tobar A. Staged Repair of Primary Aortoesophageal Fistula. Am Surg 2023; 89:3864-3866. [PMID: 37144472 DOI: 10.1177/00031348231173949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 05/06/2023]
Abstract
Primary aortoenteric fistulas are rare with an incidence reported up to .07% at autopsy. Literature review yields few reported cases, and rarer still is a fistula between a normal thoracic aorta and the esophagus. Rather, 83% of cases are associated with an aneurysmal aorta and 54% involve the duodenum. Patients with aortoesophageal fistula (AEF) usually present with a triad of chest pain, dysphasia, and a herald bleed. Without treatment, AEFs will result in exsanguination and are universally fatal; even with traditional open surgical treatment, mortality is reported over 55%. The complex pathology of AEFs makes repair more challenging, given an infected field, friable tissue, and patients who are often hemodynamically unstable. Staged repair using endografts as initial treatment with the primary goal of controlling bleeding and preventing fatal exsanguination has been reported. We present a case where a descending thoracic aorta to esophageal fistula was repaired, and this strategy was utilized.
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Affiliation(s)
- Kimberly S Seal
- WVU-Department of Surgery, Charleston Division, CAMC Institute of Academic Medicine, Charleston, WV, USA
| | - Shadi J Abu-Halimah
- WVU-Department of Surgery, Charleston Division, CAMC Institute of Academic Medicine, Charleston, WV, USA
| | - Benjamin W Dyer
- WVU-Department of Surgery, Charleston Division, CAMC Institute of Academic Medicine, Charleston, WV, USA
| | - Edward C Tobin
- WVU-Department of Surgery, Charleston Division, CAMC Institute of Academic Medicine, Charleston, WV, USA
| | - Andre Jadue-Tobar
- Department of Surgery, Cardiothoracic Division, CAMC Institute of Academic Medicine, Charleston, WV, USA
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Juan Casamayor L, Martínez Cuevas C, Fuentes-Valenzuela E, Alonso-Martín C. Esophageal necrosis secondary to thoracic aortic aneurysm. Rev Esp Enferm Dig 2023; 115:472-473. [PMID: 37073714 DOI: 10.17235/reed.2023.9580/2023] [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] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
We present the case of a 78-year-old man with dyslipidemia with ongoing treatment with statins. He was admitted for a history of 3-month dysphagia and weight loss. The physical exam was unremarkable. Blood tests revealed anemia (hemoglobin 11,5 g/dL). Gastroscopy showed a partially stenotic bulging ulcer in the middle esophagus, with a fibrinous base and residual clot Histopathology ruled out any malignancy and confirmed the presence of transmural necrosis with infiltration of inflammatory cells. Computed tomography (CT) revealed a 11x11x12 cm thoracic aortic aneurysm, with an intramural 4 cm thrombus in the anterolateral wall. The patient was referred for urgent Vascular Surgery, but unfortunately, he presented massive hematemesis with cardiorespiratory arrest, and despite cardiopulmonary resuscitation, he died.
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Al-Taie B, Rosvall O, Larsson M, Edholm D. Button battery injury causing an aorto-oesophageal fistula in a 1-year-old child - Sengstaken-Blakemore tube, a life-saving bridge during surgery. Paediatr Int Child Health 2023; 43:19-22. [PMID: 38018156 DOI: 10.1080/20469047.2023.2277506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 10/26/2023] [Indexed: 11/30/2023]
Abstract
ABBREVIATION AEF: aorto-oesophageal fistula;BB: button battery;CTA: computed tomography angiography;ER: emergency room;GI: gastro-intestinal;SBT: Sengstaken-Blakemore tube.
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Affiliation(s)
- Baraa Al-Taie
- Department of Surgery, Linköping University Hospital and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Oda Rosvall
- Department of Surgery, Linköping University Hospital and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Magnus Larsson
- Department of Surgery, Linköping University Hospital and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - David Edholm
- Department of Surgery, Linköping University Hospital and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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8
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Sun P, Ren PW, Zhang JR, Zuo L, Yin YN, Shi JY, Zhu H, Yang S, Luo YX, Liu D. [Related factors and prognosis analysis of esophagorespiratory fistula after esophageal cancer surgery]. Zhonghua Yi Xue Za Zhi 2022; 102:3510-3514. [PMID: 36418248 DOI: 10.3760/cma.j.cn112137-20220707-01506] [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: 06/16/2023]
Abstract
Objective: To explore the factors associated with the development of esophagorespiratory fistula (ERF) after esophageal cancer surgery and its relationship with patient survival. Methods: A total of 241 patients with esophageal cancer after surgery, who received postoperative sputum suction through bronchoscope from West China Hospital of Sichuan University between January and December 2021 were included. The clinical data and airway features under bronchoscope of these patients were collected. Of the 241 patients, 203 were males (84.2%) and 38 were females (15.8%), aged (63.63±8.05) years. The related factors of ERF were analyzed by multivariate logistic regression analysis, and Kaplan-meier was used to analyze the relationship between bronchoscopic specific manifestations, treatment modality and patient survival. Results: Of the 241 postoperative patients with esophageal cancer, 21 (8.7%) developed ERF. There were 39 (16.2%) patients with bronchoscopic specific manifestations, including 16 cases (6.6%) of hyperemia, 13 cases (5.4%) of congestion, and 15 cases (6.2%) of erosion. Bronchoscopic specific manifestations of tracheal mucosa (OR=13.734, 95%CI: 3.535-29.074, P<0.001) and thoracotomy (OR=9.121, 95%CI 1.843-44.237, P=0.007) were independent risk factors for the development of ERF, and preoperative chemotherapy (OR=0.128, 95%CI: 0.052-0.607, P=0.006) was a protective factor in the occurrence of ERF. The median survival time was 224 (95%CI: 95-353)d in the stent-treated group (14 patients) after the onset of ERF, and the median survival time of patients in the supportive care group (7 patients) was 29 (95%CI: 8-50)d, and the survival difference was statistically significant (χ2=5.69, P=0.017). Conclusions: Bronchoscopic specific manifestations are independent risk factors for the development of ERF in postoperative patients with esophageal cancer and are useful in assessing the risk of developing ERF. After the occurrence of postoperative ERF, timely intervention by insertion of tracheal stents to seal the fistula may prolong the survival time of the patients.
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Affiliation(s)
- P Sun
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - P W Ren
- Department of Clinical Research Management, West China Hospital, Sichuan University, Chengdu 610041, China
| | - J R Zhang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - L Zuo
- Department of Integrated Care Management Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Y N Yin
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - J Y Shi
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - H Zhu
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - S Yang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Y X Luo
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - D Liu
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
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9
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Abstract
Aortoesophageal fistula, a rare and potentially fatal disease, is an abnormal connection between the aorta and esophagus. We have recently identified a case of aortoesophageal fistula, but it was characterized by submucosal bulge of esophagus, not gastrointestinal bleeding. And he was treated promptly.
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Affiliation(s)
- Sai Li
- Interventional Radiology Center, Xiangya Hospital Central South University, China
| | - Yong Li
- Gastroenterology, Xiangya Hospital Central South University, China
| | - Liangrong Shi
- Interventional Radiology Center, Xiangya Hospital Central South University,
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10
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Byard RW. Causes of sudden death related to oesophageal carcinoma. Med Sci Law 2021; 61:69-72. [PMID: 32990174 DOI: 10.1177/0025802420962353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Two cases of recently diagnosed oesophageal squamous-cell carcinomas in men, both aged 72 years, are reported that resulted in rapid clinical deterioration and death from upper-airway occlusion and haemorrhage, respectively. In the first case, direct growth of the tumour from metastatic deposits in the paratracheal lymph nodes through the wall of the trachea resulted in lethal acute airway occlusion. In the second case, local extension of the tumour through the wall of the oesophagus into the adjacent aorta resulted in an aorto-oesophageal fistula which led to catastrophic and fatal haemorrhage. Although rare, oesophageal squamous-cell carcinomas may cause unexpected death due to quite different mechanisms, and result in the need for a detailed medico-legal assessment.
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Affiliation(s)
- Roger W Byard
- Forensic Science SA and School of Medicine, The University of Adelaide, Australia
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Benedetti B, Felice M, Locco F, Roberti P, Demontis R. Lethal aorto-oesophageal fistula 16 years after aortic prosthetic reconstruction: Delayed rupture as cause of death. Med Sci Law 2021; 61:146-149. [PMID: 32689878 DOI: 10.1177/0025802420936796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The development of aorto-oesophageal fistula (AOF) is a rare complication following thoracic aortic repair. Mortality is high, in most cases due to fatal haematemesis. The clinical onset is variable, occurring approximately one year after surgery. We report a case of a lethal AOF in a 58-year-old man. He underwent open vascular surgery 16 years prior to his death due to a rupture of the descending thoracic aorta. In the early 2000s, the open vascular approach was replaced by thoracic endovascular aortic repair. As a result of this approach, the number of surgical complications has reduced, with the exception of AOF.
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Affiliation(s)
- Beatrice Benedetti
- Legal Medicine Unit, Department of Medical Sciences and Public Health,3111University of Cagliari, Italy
| | - Marica Felice
- Legal Medicine Unit, Department of Medical Sciences and Public Health,3111University of Cagliari, Italy
| | - Francesco Locco
- Legal Medicine Unit, Department of Medical Sciences and Public Health,3111University of Cagliari, Italy
| | - Paola Roberti
- Legal Medicine Unit, Department of Medical Sciences and Public Health,3111University of Cagliari, Italy
| | - Roberto Demontis
- Legal Medicine Unit, Department of Medical Sciences and Public Health,3111University of Cagliari, Italy
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Abstract
OBJECTIVES Ingestion of a foreign body can cause different degrees of damage to esophagus, and several complications are potentially life-threatening if not properly handled. The aortic injury caused by a perforating esophageal foreign body is rare but lethal. The optimal management still remains controversial. The purpose of this report is to describe our experience in the management of the aortic injury caused by esophageal foreign body ingestion. METHODS Between January 2015 and December 2015, we retrospectively enrolled cases of esophageal perforation involving the aorta by foreign body. The general parameters, esophageal foreign body, types of aortic injury, treatment, and outcome were analyzed. Additionally, we reviewed the literature of the management of esophageal perforation involving the aorta caused by foreign bodies. The study was approved by the ethics committee of the First Affiliated Hospital, College of Medicine, Zhejiang University, and the need for informed consent was waived (Quick review 2019, No. 609). RESULTS Three cases of esophageal perforation involving the aorta by foreign body was selected in the study. Two male and 1 female patients (range, 51-58 years old) with the aorta involvement caused by a perforating foreign body in the esophagus in 3 forms were identified, including 1 patient with mycotic aortic pseudoaneurysm, 1 patient with aortoesophageal fistula and 1 patient with the aortic intramural hematoma. One patient died of the rupture of the pseudoaneurysm during the preparation of the surgery. The other 2 patients were cured with a multidisciplinary approach, which is an urgent thoracic endovascular aortic repair followed by mediastinal debridement/drainage or endoscopic retrieval. Two of 3 patients were survived until now. CONCLUSION The management of the aortic injury caused by esophageal foreign body injury is challenging. Early diagnosis and multidisciplinary management is crucial.
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Pejic RN, Gabrielson AT. 36-year-old man • persistent dry cough • frequent sinus congestion • hemoptysis • Dx? J Fam Pract 2020; 69:255-256. [PMID: 32555757] [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: 06/11/2023]
Abstract
► Persistent dry cough ► Frequent sinus congestion ► Hemoptysis.
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Affiliation(s)
- Rade N Pejic
- Department of Family Medicine, Tulane University, New Orleans, LA, USA.
| | - Andrew T Gabrielson
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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14
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Merlo A, Farber M, Ohana E, Pascarella L, Crowner J, Long J. Aberrant Right Subclavian Artery to Esophageal Fistula: A Rare Case and Its Management. Ann Thorac Surg 2020; 110:e85-e86. [PMID: 32035051 DOI: 10.1016/j.athoracsur.2019.12.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 10/13/2019] [Revised: 12/08/2019] [Accepted: 12/16/2019] [Indexed: 11/17/2022]
Abstract
A 29-year-old woman underwent esophageal stent placement after developing esophageal stenosis in the setting of tracheoesophageal fistula repair in childhood. The patient developed hemoptysis from an esophageal to aberrant right subclavian artery fistula; this was managed with several staged procedures involving arterial stent placement, carotid-to-subclavian bypass, and aberrant subclavian artery ligation. The patient then underwent pericardial patch repair of her perforated esophagus. This case illustrates the importance of understanding congenital anatomy and frequent associations, such as tracheoesophageal fistula and aberrant right subclavian artery; furthermore, it demonstrates the importance of multidisciplinary care for complex cases.
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Affiliation(s)
- Aurelie Merlo
- Division of Cardiothoracic Surgery, Department of Surgery, University of North Carolina, Chapel Hill, North Carolina.
| | - Mark Farber
- Division of Vascular Surgery, Department of Surgery, University of North Carolina, Chapel Hill, North Carolina
| | - Elad Ohana
- Division of Vascular Surgery, Department of Surgery, University of North Carolina, Chapel Hill, North Carolina
| | - Luigi Pascarella
- Division of Vascular Surgery, Department of Surgery, University of North Carolina, Chapel Hill, North Carolina
| | - Jason Crowner
- Division of Vascular Surgery, Department of Surgery, University of North Carolina, Chapel Hill, North Carolina
| | - Jason Long
- Division of Cardiothoracic Surgery, Department of Surgery, University of North Carolina, Chapel Hill, North Carolina
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Castelo D, Melo PC, Florim S, Pires FC, Portugal P. Spontaneous Aortoesophageal Fistula And Ruptured Aortic Aneurysm - A Case Report On Combined Aortic And Esophageal Prosrhesis Palliative Treatment. Rev Port Cir Cardiotorac Vasc 2020; 27:39-42. [PMID: 32239824] [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] [Received: 12/18/2019] [Indexed: 06/11/2023]
Abstract
Aortoesophageal fistulas are uncommon, dreadful vascular events, most frequently found in the setting of thoracic aorta aneurysms. Patients usually present with thoracic pain, dysphagia and sentinel hematemesis - the Chiari triad - followed by life threatening hematemesis. Emergent open surgery with debridement of necrotic tissue and in situ aortic graft repair is currently the best strategy. However, in patients which cannot withstand surgery, endovascular repair is currently gaining acceptance as a palliative treatment or as a bridge to surgery. We present a case of a 55-year-old female with a past of heavy alcohol abuse and a previously unknown massive aortic aneurysm, who presented to the emergency department complai- ning of acute dysphagia and epigastric pain. An abdominal ultrasound revealed left pleural effusion and suspected clots in the pleural space. A thoracic CTA was promptly done, where a spontaneous ruptured aortic aneurysm with aortoesophageal fistula was discovered. The team, fearing open surgery due to poor cardiac function, opted for a thoracic endovascular aortic repair. The aortoesophageal fistula dissected the esophageal wall in all of its thickness without rupture into the lumen. This was complicated with esophageal ischemia, aneurysmal sac infection and mediastinitis. Because the patient was in shock, in order to help control the infection, an esophageal prosthesis was placed, followed by proximal esophagostomy, distal esophageal closure and gastrostomy. Six months after initial presentation, the patient died at the emergency room, shortly after reentering with massive hematemesis and hypovolemic shock of undetermined origin.
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Affiliation(s)
- Diogo Castelo
- Serviço de Imagiologia do Centro Hospitalar de Vila Nova de Gaia / Espinho, Portugal
| | - Pedro Cabral Melo
- Serviço de Imagiologia do Centro Hospitalar de Vila Nova de Gaia / Espinho, Portugal
| | - Sofia Florim
- Serviço de Imagiologia do Centro Hospitalar de Vila Nova de Gaia / Espinho, Portugal
| | - Fernando Calejo Pires
- Serviço de Imagiologia do Centro Hospitalar de Vila Nova de Gaia / Espinho, Portugal
| | - Pedro Portugal
- Serviço de Imagiologia do Centro Hospitalar de Vila Nova de Gaia / Espinho, Portugal
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Abstract
RATIONALE Aortoesophageal fistula (AEF) is the direct communication between the aorta and esophagus, which can cause fatal hemorrhage, and its incidence increased with the use of an esophageal stent (ES). PATIENT CONCERNS A 79-year-old man was admitted due to hemodynamic shock with massive hematemesis caused by AEF 1 month after the implantation of an ES. DIAGNOSES Computed tomography angiography visualized an AEF with an ulcer-like projection on the aortic arch where the ES was placed. Angiography of the aorta revealed extravasation of contrast media from the aortic arch into the stented esophagus, which confirmed the diagnosis. INTERVENTIONS Thoracic endovascular aortic repair (TEVAR) was performed for massive hematemesis caused by ES-related, AEF but did not solve the underlying problem, leading to the second fatal hemorrhage. LESSONS TEVAR for the unique treatment of ES-related AEF is feasible in certain cases but may lead to collapse after a specific period.
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17
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Spontaneous mediastinal abscess of curious causation. J Paediatr Child Health 2019; 55:874-5. [PMID: 31270871 DOI: 10.1111/jpc.2_14486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 04/10/2019] [Indexed: 11/30/2022]
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18
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Alharbi SR. Tuberculous esophagomediastinal fistula with concomitant mediastinal bronchial artery aneurysm-acute upper gastrointestinal bleeding: A case report. World J Gastroenterol 2019; 25:2144-2148. [PMID: 31114140 PMCID: PMC6506583 DOI: 10.3748/wjg.v25.i17.2144] [Citation(s) in RCA: 2] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/29/2019] [Accepted: 04/20/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Esophagomediastinal fistula is a very rare complication of tuberculosis in otherwise healthy adults, and mediastinal bronchial artery aneurysm is even rarer. In this case report, we describe a rare case of tuberculosis complication that presented with acute upper gastrointestinal (GI) bleeding. It also highlights the benefits of chest computed tomography (CT) as an excellent adjunct diagnostic tool to endoscopy and bronchoscopy and the role of trans-arterial embolization as a minimal invasive therapy alternative to surgery.
CASE SUMMARY A 19-year-old medically free male patient presented with acute multiple episodes of hematemesis for 1 d. Upper GI endoscopy, bronchoscopy, and chest CT with IV contrast confirmed esophagomediastinal fistula with mediastinal bronchial artery aneurysm. After resuscitating patient with IV fluid and blood product transfusion, trans catheter embolization was performed for mediastinal bronchial artery aneurysm.
CONCLUSION We successfully treated a patient with acute upper GI bleeding due to tuberculous esophagomediastinal fistula and mediastinal bronchial artery aneurysm using transcatheter coil embolization.
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Affiliation(s)
- Sultan R Alharbi
- Interventional Radiology Unit, King Saud University Medical City, Collage of Medicine, King Saud University, Riyadh 11472, Saudi Arabia
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19
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Abstract
A 79-year-old man with appetite loss and nausea for 1 month was admitted to our hospital. His thoracic aortic aneurysm had gradually increased in size due to perigraft endoleak after the previous aneurysm repair surgery. Although he showed no hematemesis, melena, or a fever, gastrointestinal endoscopy and contrast-enhanced computed tomography (CT) revealed an aortoesophageal fistula (AEF). He developed septic shock due to a perigraft abscess and eventually died, although aortic graft replacement and esophageal transection were performed. Clinical suspicion is the most important factor for obtaining an accurate diagnosis and improving the prognosis in cases of AEF.
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Affiliation(s)
- Norie Takei
- Department of General Internal Medicine, Matsunami General Hospital, Japan
| | - Takeshige Kunieda
- Department of General Internal Medicine, Matsunami General Hospital, Japan
| | - Yoshitaka Kumada
- Department of Cardiovascular Surgery, Matsunami General Hospital, Japan
| | - Masanori Murayama
- Department of General Internal Medicine, Matsunami General Hospital, Japan
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20
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So K, Smith CR, Faroqui NM, Simone N, Senkowski A, Patel SK, Bailey BM. Control of Aortoesophageal Fistula Using Endoscopic and Endovascular Techniques: A Palliative Intervention. Am Surg 2018; 84:e47-e49. [PMID: 30454475] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Kristine So
- Division of General Surgery, Memorial University Medical Center, Savannah, Georgia, USA
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21
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Bhardwaj R, Rana V, Sharma B. Hydropneumopericardium. J Assoc Physicians India 2017; 65:97. [PMID: 28799314] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
| | | | - Brij Sharma
- Associate Professor, Gastroenterology, Indira Gandhi Medical College, Shimla, Himachal Pradesh
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22
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Uesato M, Kono T, Akutsu Y, Murakami K, Kagaya A, Muto Y, Nakano A, Aikawa M, Tamachi T, Amagai H, Arasawa T, Muto Y, Matsubara H. Endoscopic occlusion with silicone spigots for the closure of refractory esophago-bronchiole fistula after esophagectomy. World J Gastroenterol 2017; 23:5253-5256. [PMID: 28811720 PMCID: PMC5537192 DOI: 10.3748/wjg.v23.i28.5253] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 02/03/2017] [Revised: 05/04/2017] [Accepted: 06/12/2017] [Indexed: 02/06/2023] Open
Abstract
A 65-year-old man with cT1bN0M0 stage I middle thoracic esophageal cancer underwent subtotal esophagectomy and gastric tube reconstruction through the posterior mediastinal route after preoperative carbon-ion radiotherapy and chemotherapy in a clinical trial. Anastomotic leakage occurred, but it spontaneously improved. At six months after the operation, he was rehospitalized with a cough and dysphagia. An esophago-bronchiole fistula and stenosis of the gastric tube were observed. He first underwent stent placement in the gastric tube. Two weeks later, the syringeal epithelium was burned by argon plasma coagulation after stent removal. Endoscopic occlusion was then performed for the fistula with two guidewire-assisted silicone spigots. Two weeks later, he was discharged on an oral diet, and he has not developed recurrence of the fistula or cancer for three years. This is the first report of endoscopic occlusion with a guidewire-assisted silicone spigot through the esophagus.
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23
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Katz-Agranov N, Nevah Rubin MI. Severe esophageal injury after radiofrequency ablation - a deadly complication. World J Gastroenterol 2017; 23:3374-3378. [PMID: 28566899 PMCID: PMC5434445 DOI: 10.3748/wjg.v23.i18.3374] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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: 11/22/2016] [Revised: 01/18/2017] [Accepted: 02/08/2017] [Indexed: 02/06/2023] Open
Abstract
Various degrees of esophageal injury have been described after radiofrequency ablation performed for treatment of atrial fibrillation. The main mechanism of injury is thermal and may lead to a range of esophageal mucosal changes, some clinically insignificant, however when deep ulceration occurs, this may be further complicated by perforation and mediastinitis, a rare but life threatening sequelae. We present a case of a severe esophageal injury leading to mediastinitis, with interesting endoscopic findings.
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24
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Schuurmans MM, Benden C, Moehrlen C, Gubler C, Wilhelm M, Weder W, Inci I. Esophagopericardial fistula, septic shock and intracranial hemorrhage with hydrocephalus after lung transplantation. Rev Port Pneumol (2006) 2017; 23:156-159. [PMID: 28237439 DOI: 10.1016/j.rppnen.2017.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 06/21/2016] [Revised: 12/25/2016] [Accepted: 01/15/2017] [Indexed: 11/15/2022] Open
Abstract
A 57-year old woman underwent lung transplantation for non-specific interstitial pneumonia. Primary graft dysfunction was diagnosed requiring continued use of extracorporeal membrane oxygenation (ECMO). Within three days she developed recurring hemothoraces requiring two surgical evacuations. After ECMO removal a series of complications occurred within four months: femoral thrombosis, persisting tachycardic atrial fibrillation, pneumopericardium with an esophagopericardial fistula and purulent pericarditis, septic shock, multiorgan failure and intracerebral hemorrhage with ventricular involvement requiring external ventricular drainage. Interdisciplinary management coordinated by the intensive care specialist, transplant surgeon and pulmonologist with various interventions by the respective specialists followed by intensive physical rehabilitation allowed for discharge home on day 235 post transplant. Subsequently quality of life was considered good by the patient and family.
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Affiliation(s)
- M M Schuurmans
- University Hospital Zurich, Pulmonology, Zurich, Switzerland.
| | - C Benden
- University Hospital Zurich, Pulmonology, Zurich, Switzerland
| | - C Moehrlen
- University Hospital Zurich, Anaesthesiology, Zurich, Switzerland
| | - C Gubler
- University Hospital Zurich, Gastroenterology, Zurich, Switzerland
| | - M Wilhelm
- University Hospital Zurich, Cardiac Surgery, Zurich, Switzerland
| | - W Weder
- University Hospital Zurich; Thoracic Surgery, Zurich, Switzerland
| | - I Inci
- University Hospital Zurich; Thoracic Surgery, Zurich, Switzerland
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25
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Alberca de Las Parras F, Navalón Rubio M, Egea Valenzuela J. Management of refractory esophageal stenosis in the pediatric age. Rev Esp Enferm Dig 2016; 108:627-636. [PMID: 27650677 DOI: 10.17235/reed.2016.3671/2015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Refractory esophageal stenosis (RES) is a major health problem in the pediatric population. Several techniques such as stent placement or C-mitomycin (CM) have been described as alternative treatments. We present our experience with both techniques, in our case with biodegradable stents (BS) and sometimes the association with stents and CM. MATERIAL AND METHODS Six patients have been included: 2 post-operative fistulas in patients with type I esophageal atresia; 1 operated atresia without fistula; and 3 caustic strictures. 5 BS were placed in 4 children: 3 of them in cases of atresia (2 prosthesis in one case) and the other one in a case of stricture. CM was used in 5 cases: in 2 of them from the beginning, and in the other 3 cases after failure of the stent. RESULTS When placed in fistulas, BS were fully covered. One of them successfully treated the fistula, but the other one was not effective. One stenosis was successfully treated with SB (in the case of persistent fistula), but recurrence was observed in the other 2 cases. One of these was solved with CM, and the other one needed a second stent. In the remaining 2 cases (one atresia and one caustic stricture) CM was effective after 1 and 2 sessions respectively. Overall, 5 out of 6 stenosis have been successfully treated (83.3%), and 1 out of 2 fistulas (50%). CONCLUSIONS Association of BS and CM has been effective in the management of RES in children.
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26
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Tian W, Hu Z, Ji J, Xu D, You Z, Guo W, Xu K. [Application of bundles of intervention in the treatment of esophageal carcinoma anastomotic leak]. Zhonghua Wei Chang Wai Ke Za Zhi 2016; 19:1009-1013. [PMID: 27680069] [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: 06/06/2023]
Abstract
OBJECTIVE To investigate the application of bundles of intervention in the treatment of esophageal carcinoma anastomotic leak. METHODS From January 2014 to May 2015, 44 cases of esophageal carcinoma anastomotic fistula were treated by bundles of intervention (through the collection of a series of evidence-based treatment and care measures for the treatment of diseases) in Department of Thoracic Surgery, Huai'an First Hospital, Nanjing Medical University (bundles of intervention group), and 68 patients with esophageal carcinoma postoperative anastomotic leak from December 2013 to January 2012 receiving traditional therapy were selected as the control group. The clinical and nutritional indexes of both groups were compared. RESULTS There were no significant differences in general data and proportion of anastomotic leak between the two groups. Eleven patients died during hospital stay, including 3 cases in bundles of intervention group(6.8%) and 8 cases in control group (11.8%) without significant difference(P = 0.390). In bundles of intervention group, 1 case died of type III( intrathoracic anastomotic leak, 2 died of type IIII( intrathoracic anastomotic leak. In control group, 2 cases died of type III( cervical anastomotic leak, 2 died of type III( intrathoracic anastomotic leak and 4 of type IIII( intrathoracic anastomotic leak. The mortality of bundles of intervention group was lower than that of control group. The duration of moderate fever [(4.1±2.4) days vs. (8.3±4.4) days, t=6.171, P=0.001], the time of antibiotic use [(8.2±3.8) days vs.(12.8±5.2) days, t=5.134, P = 0.001], the healing time [(21.5±12.7) days vs.(32.2±15.8) days, t=3.610, P=0.001] were shorter, and the average hospitalization expenses[(63±12) thousand yuan vs. (74±19) thansand yuan, t=3.564, P=0.001] was lower in bundles of intervention group than those in control group. Forty-eight hours after occurrence of anastomotic leak, the levels of hemoglobin, albumin and prealbumin were similar in both groups. However, at the time of fistula healing, the levels of hemoglobin [(110.6±10.5) g/L vs.(103.8±11.1) g/L, t=3.090, P=0.002], albumin [(39.2±5.2) g/L vs.(36.3±5.9) g/L, t=2.543, P=0.013] and prealbumin [(129.3±61.9) g/L vs.(94.1±66.4) g/L, t=2.688, P=0.008] were significantly higher in bundles of intervention group. CONCLUSION In the treatment of postoperative esophageal carcinoma anastomotic leak, application of bundles of intervention concept can significantly improve the nutritional status and improve the clinical outcomes.
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Affiliation(s)
| | | | - Jian Ji
- Department of Thoracic Surgery, Huai'an First Hospital, Nanjing Medical University, Jiangsu Huai'an 223300, China.
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27
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Seow DG, Chan PF, Chia BL, Loh JP. Fever in a Patient with a Previous Gastrectomy. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2016; 45:117-120. [PMID: 27146466] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Debra Gf Seow
- Cardiac Department, National University Heart Centre, Singapore
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28
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Sager HB, Wellhöner P, Wermelt JA, Schunkert H, Kurowski V. Lethal hemorrhage caused by aortoesophageal fistula secondary to stent-graft repair of the thoracic aorta. Cardiovasc Intervent Radiol 2015; 34 Suppl 2:S60-3. [PMID: 20390273 DOI: 10.1007/s00270-010-9844-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [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: 01/06/2010] [Accepted: 03/06/2010] [Indexed: 11/28/2022]
Abstract
Aortoesophageal fistula (AEF) is a rare but life-threatening complication after endovascular or surgical aortic repair. Here we report a patient with AEF secondary to aortic stent-placement 2 years earlier who presented with hematemesis and died from hemorrhagic shock. By means of this case and the literature, we highlight potential bleeding sources in such a scenario because this is of crucial importance for the management strategy.
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Affiliation(s)
- Hendrik B Sager
- Medizinische Klinik II, Universität zu Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany,
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29
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Doğan R, Dikmen E, Önder S. Intralobar pulmonary sequestration associated with congenital broncho-esophageal fistula. Turk J Pediatr 2015; 57:311-314. [PMID: 26701956] [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: 06/05/2023]
Abstract
Pulmonary sequestration and congenital broncho-esophageal fistula are both rare malformations; nonetheless, in the presence of recurrent pulmonary infection, the possibility that one or the other may be involved should not be disregarded. To our knowledge, the concurrence of intralobar pulmonary sequestration and congenital broncho-esophageal fistula is very rare. Herein, we report a case of intralobar pulmonary sequestration combined with congenital broncho-esophageal fistula, both of which were successfully treated with surgery.
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Affiliation(s)
- Rıza Doğan
- Department of Thoracic Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey.
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30
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van Adrichem S, Didden P, van Lanschot JJBJ. [A man with chest pain and dyspnoea]. Ned Tijdschr Geneeskd 2015; 159:A8275. [PMID: 25654684] [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: 06/04/2023]
Abstract
A 60-year-old man presented with acute chest pain and dyspnoea, which was caused by pericarditis secondary to a neo-oesophago-pericardial fistula after previous oesophagectomy for oesophageal cancer. The fistula presumably originated from a penetrating peptic ulcer.
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31
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Yeow Y, Fong SS, Rao J, Sim R. Aorto-oesophageal fistula from miliary tuberculosis: a rare cause of massive haematemesis. Ann Acad Med Singap 2014; 43:559-560. [PMID: 25523860] [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] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Yuyi Yeow
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
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32
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Kawahara Y, Nomura T, Masaki N, Kobayashi Y, Sato H, Arai S, Fukasawa M. [Successful management of aorto-esophageal fistula, using staged 3 times operation]. Kyobu Geka 2014; 67:383-386. [PMID: 24917284] [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 66-year-old man, presented with hematemesis and hemorrhagic shock, was transported to our institution. Computed tomographic examination suggested a pseudo-aneurysm formed by bleeding from aorto-esophageal fistula( AEF). We planned staged operations. At first, in an emergent operation, graft replacement of descending aorta, was performed under partial cardiopulmonary bypass, by left thoracotomy approach. AEF was 5 mm in diameter, and existed inside of normal-diameter and non-aneurysmal aortic intima. AEF orifice into pseudo-aneurysm was closed with aortic wall and was sutured tightly. Next day, gastrointestinal fiberscopy was performed, and penetrating ulcer was found at lower esophagus.To prevent infective complications, the 2nd operation, subtotal esophagectomy, cervical esophagostomy, gastrostomy and tube ileostomy were performed by right thoracotomy approach. Post- operative course was uneventful. Two months later, 3rd operation, cervical esophago-gastric anastomosis was performed, uneventfully. Two years and four months elapsed, and no evidences of infection and formation of pseudo-aneurysm were observed.
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Affiliation(s)
- Yu Kawahara
- Department of Cardiovascular Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan
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33
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Eche A, Dahan B, Santin A, Renaud B. [An upper gastro-intestinal bleeding reveals an aortoesophageal fistula due to the rupture of a thoracic aortic aneurysm]. ACTA ACUST UNITED AC 2014; 33:285-7. [PMID: 24630170 DOI: 10.1016/j.annfar.2014.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 02/11/2014] [Indexed: 11/19/2022]
Affiliation(s)
- A Eche
- Département des urgences, CHU Cochin - Hôtel-Dieu, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Université Paris V, Descartes, 15, rue de l'École-de-Médecine, 75006 Paris, France.
| | - B Dahan
- Département des urgences, CHU Cochin - Hôtel-Dieu, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Université Paris V, Descartes, 15, rue de l'École-de-Médecine, 75006 Paris, France
| | - A Santin
- Département des urgences, CHU Cochin - Hôtel-Dieu, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - B Renaud
- Département des urgences, CHU Cochin - Hôtel-Dieu, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Université Paris V, Descartes, 15, rue de l'École-de-Médecine, 75006 Paris, France
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34
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Fernández-Carrillo C, Herreros-de-Tejada A, Salas C, Ramos L, Suárez C, Abreu L. Infectious esophagic fistula: A common virus with an extraordinary presentation. Rev Esp Enferm Dig 2013; 105:56-57. [PMID: 23548016 DOI: 10.4321/s1130-01082013000100014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Abstract
We herein present the case of a 56-year-old Japanese woman who developed purulent pericarditis after undergoing chemoradiotherapy for esophageal cancer. She developed epigastralgia and a fever and was admitted to our hospital. A physical examination revealed hypotension, tachycardia and pericardial friction rub. Echocardiography revealed moderate pericardial effusion. Based on these observations, the patient was diagnosed with cardiac tamponade. Computed tomography confirmed the presence of an esophagopericardial fistula. Treatment with pericardiocentesis, drainage and short-term intrapericardial administration of antibiotics relieved the patient's symptoms. Daily rinsing through a catheter with normal saline prevented relapse of the purulent pericarditis. Esophagopericardial fistulas are so rare that their treatment is not well-established. We herein report successful palliative care of a malignant esophagopericardial fistula associated with purulent pericarditis.
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Affiliation(s)
- Tsugumi Takayama
- Departments of Cardiology, Niigata Cancer Center Hospital, Japan
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36
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37
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Affiliation(s)
- Yi-Tso Cheng
- Department of Thoracic and Cardiovascular Surgery, Buddhist Tzu Chi General Hospital, Taiwan
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38
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Kokuho N, Hayashi H, Matsuyama M, Miura Y, Hayashihara K, Saito T. [A case of pulmonary Mycobacterium abscessus disease complicated with esophago-pulmonary fistula causing repeated exacerbation]. Nihon Kokyuki Gakkai Zasshi 2010; 48:696-701. [PMID: 20954373] [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
We report a case of fatal pulmonary infection caused by Mycobacterium abscessus in a middle-aged patient with acquired esophago-pulmonary fistula which contributed to repeated exacerbation. Acquired benign esophago-pulmonary fistula is uncommon. After a 55-year-old woman was diagnosed with pulmonary Mycobacterium avium disease in 1989 and improved with multidrug chemotherapy, she developed pulmonary M. abscessus in 2001. Despite multi-drug treatment, she suffered repeated exacerbation and her condition gradually deteriorated. Chest computed tomography (CT) showed esophago-pulmonary fistula which was comfermed by esophagoscopy. An M. abscess infection may give rise to adhesions between the tracheobronchial lymph nodes and the neighboring esophagus, with subsequent development of a traction diverticulum which may extend to the tracheobronchial tree. In the present case, aspiration of liquids through the fistula induced a cough reflex, and M. abscessus spread through the airway. It might be possible that esophago-pulmonary fistula is not only a complication of pulmonary M. abscessus infection but also an exacerbation factor.
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Affiliation(s)
- Nariaki Kokuho
- Department of Respiratory Medicine, National Hospital Organization, Ibarakihigashi National Hospital
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39
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Khatib N, Belossesky R, Marwan O, Weiner Z. Fetal bowel calcifications: a sign of anal atresia with rectourethral fistula. J Clin Ultrasound 2010; 38:332-334. [PMID: 20544871 DOI: 10.1002/jcu.20706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Fetal bowel calcifications were observed at 24 weeks of gestation in a male fetus, suggesting an anorectal malformation (ARM) with rectourethral fistula. At birth, the newborn presented with complex ARM including anal atresia, rectourethral fistula, and esophageal atresia. The prenatal sonographic visualization of calcifications within distended bowel should raise the suspicion of ARM including anal atresia and rectourethral fistula, the presence of such calcification depending on the timing of onset of fistula formation.
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Affiliation(s)
- Nizar Khatib
- Department of Ob-Gyn, Rambam Health care Campus, POB 9602, Haifa, 31096, Israel
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40
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Abstract
A 73-year-old man was admitted to the hospital due to severe hematemesis and collapse, severe anemia and inflammation. Two months ago, the patient had been treated with antibiotics due to septicemia with staphylococcus aureus. At that time CT scan had shown only thoracic arteriosclerosis. The subsequent high urgency upper endoscopy identified a circular mucosal defect in distal esophagus as bleeding origin. The patient died 10 hours after admission. Performing autopsy, a fistula between the thoracic aortic aneurysm and the distal esophagus was found in the background of severe arteriosclerosis. The rapid onset of an aneurysm with rupture after a bacterial infection is typical for a mycotic aneurysm.
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Affiliation(s)
- Y Vogel
- Abteilung für Innere Medizin, Klinik Blankenstein, Im Vogelsang 5-11, 45527, Hattingen, Germany.
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41
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Timen LI, Shertsinger AG, Zhigalova SB, Chikunova BZ, Markarov AE, Fedotov EV, Nazar'ev PI. [Aneurysm of the thoracic aorta with esophageal perforation]. Eksp Klin Gastroenterol 2010:82-84. [PMID: 20731170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Aneurysms of a chest department of an aorta with esophageal perforation two cases are presented and a lethal outcome. Difficulties in diagnostics have been caused by rare occurrence of the given pathology, insufficient experience of clinical physicians, and also absence during supervision of characteristic attributes Aortoesophageal Fistula.
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42
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Marone EM, Coppi G, Kahlberg A, Tshomba Y, Chiesa R. Combined endovascular and surgical treatment of primary aortoesophageal fistula. Tex Heart Inst J 2010; 37:722-724. [PMID: 21224956 PMCID: PMC3014136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Primary aortoesophageal fistula is a rare cause of massive upper gastrointestinal bleeding. Conservative treatment of aortoesophageal fistula results in a 60% in-hospital mortality rate with no late survival, and conventional surgical treatment has a reported in-hospital mortality rate that approaches 40%. Thoracic endovascular aortic repair is an innovative and less invasive technique for the treatment of aortoesophageal fistula. It enables the rapid control of aortic bleeding and prevents fatal early exsanguination. However, the technique does not repair the esophagus, and there remains a substantial risk of mediastinitis and infection of the stent-graft. Herein, we report the cases of 2 patients in whom we used a combined treatment: thoracic endovascular aortic repair and delayed surgical repair of the esophagus. The esophageal repair involved direct suture of the esophageal wall and reinforcement with an intercostal muscle flap. Early follow-up evaluations suggest that our treatment of both patients was successful. We discuss the advantages and limitations of our technical choices and briefly review the pertinent medical literature.
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Affiliation(s)
- Enrico Maria Marone
- Department of Vascular Surgery, Vita-Salute University, Scientific Institute H. San Raffaele, 20132 Milan, Italy
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43
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Jonker FHW, Heijmen R, Trimarchi S, Verhagen HJM, Moll FL, Muhs BE. Acute management of aortobronchial and aortoesophageal fistulas using thoracic endovascular aortic repair. J Vasc Surg 2009; 50:999-1004. [PMID: 19481408 DOI: 10.1016/j.jvs.2009.04.043] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2009] [Revised: 04/10/2009] [Accepted: 04/17/2009] [Indexed: 11/16/2022]
Affiliation(s)
- Frederik H W Jonker
- Section of Vascular Surgery, Department of Surgery at Yale University School of Medicine, New Haven, CT 06510, USA
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44
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Bona D, Laface L, Siboni S, Schaffer M, Baldoli D, Sironi A, Sorba F, Bonavina L. [Self-expanding oesophageal stents: comparison of Ultraflex and Choostent]. Chir Ital 2009; 61:641-646. [PMID: 20380272] [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: 05/29/2023]
Abstract
Two types of covered self-expanding metal stents were compared in a consecutive series of 57 patients. Stent placement was successful in all patients. No procedure-related deaths were observed. The overall hospital morbidity was 7%. No significant differences in the efficacy of palliation of dysphagia, rate of complications, and survival rates were seen using the two types of stent. An endoscopic reintervention was required in 14% of the patients. Both stents proved to be safely removable in the short term follow-up, and the benefit of temporary insertion was documented in patients with primary oesophageal neoplasms prior to chemotherapy or chemoradiation therapy and in those with anastomotic strictures/leaks. A multidisciplinary strategy, guided by the concept that a stent should not represent the only, definitive treatment modality, may improve the quality of life of patients with advanced oesophageal carcinoma.
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Affiliation(s)
- Davide Bona
- Cattedra e UO di Chirurgia Generale, Università degli Studi di Milano, IRCCS Policlinico San Donato, Milano
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45
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Asahara M, Kitamura T, Yamada Y. [Cancer and esophagobronchial fistula: a case report]. Masui 2009; 58:1175-1178. [PMID: 19764446] [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: 05/28/2023]
Abstract
Palliative esophageal bypass surgery for patients with esophageal cancer and esophagobronchial fistula aims restoring the ability of swallowing as well as preventing pulmonary aspiration. Perioperatively, there are several problems in respiratory management for such patients. Repeated episodes of pulmonary aspiration exaggerate bronchopneumonia. Positive pressure ventilation may cause air leakage via fistula resulting in inadequate ventilation, distension of the stomach and regurgitation of gastric contents; thus, maintaining of spontaneous ventilation is a crucial concern. Here we report an anesthetic management of a 51-year-old woman with esophageal cancer and esophagobronchial fistula undergoing esophageal bypass surgery. We could not apply neuraxial block due to hypocoagulability. We performed awake tracheal intubation, and general anesthesia was maintained using sevoflurane supplemented by morphine, fentanyl and ketamine under spontaneous ventilation until the resection of gastroesophageal junction and the installation of a drainage catheter into the esophagus. Muscle relaxation required for surgery was sufficiently obtained by sevoflurane anesthesia without administration of muscle relaxants. After the installation of the drainage catheter, the lungs were ventilated mechanically until the end of surgery. The surgery was uneventful. The patient emerged from general anesthesia smoothly, and was extubated. The postoperative course of this patient was also uneventful.
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Affiliation(s)
- Miho Asahara
- Department of Anesthesiology, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655
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46
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Seet E, Beevee S, Cheng A, Lim E. The Sengstaken-Blakemore tube: uses and abuses. Singapore Med J 2008; 49:e195-e197. [PMID: 18756331] [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: 05/26/2023]
Abstract
Due to its complications including oesophageal and gastric ulceration and perforation, the Sengstaken-Blakemore tube is used far less commonly in this new millennium where endoscopic intervention is available. We discuss in a 53-year-old Indian woman an unusual life-saving use of the Sengstaken-Blakemore tube in preventing fatal exsanguination from an aortoesophageal fistula, as well as rare but devastating consequences of the insertion and residence of the Sengstaken-Blakemore tube, including acute airway obstruction and bronchoesophageal fistula.
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Affiliation(s)
- E Seet
- Department of Anaesthesia and Surgical Intensive Care, Alexandra Hospital, 378 Alexandra Road, Singapore 159964.
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Belov YV, Stepanenko AB, Gens AP, Savichev DD, Bobylev DO, Komarov RN. Primary aortoesophageal fistula: a rare variant of a ruptured chronic posttraumatic dissecting aneurysm of the descending thoracic aorta. Angiol Sosud Khir 2008; 14:133-140. [PMID: 19156065] [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: 05/27/2023]
Abstract
Presented herein is own experience in successful management of a female patient diagnosed with a primary aortoesophageal fistula secondary to a rupture of a chronic posttraumatic dissecting aneurysm of the descending thoracic aorta into the oesophagus. The contained herein review of the literature deals with the problems concerning surgical policy of and indications for different variants of reconstructive operations on the aorta and oesophagus.
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Affiliation(s)
- Yu V Belov
- Department of Surgery of the Aorta and its Branches B. V. Petrovsky Russian Research Centre of Surgery, Russian Academy of Medical Sciences, Moscow, Russia
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Millar A, Rostom A, Rasuli P, Saloojee N. Upper gastrointestinal bleeding secondary to an aberrant right subclavian artery-esophageal fistula: a case report and review of the literature. Can J Gastroenterol 2007; 21:389-92. [PMID: 17571174 PMCID: PMC2658123 DOI: 10.1155/2007/398213] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
An aberrant right subclavian artery (ARSA) is a common aortic arch abnormality. A case of a 57-year-old man presenting with melena and hypotension secondary to an ARSA-esophageal fistula is reported. The current report is unique because it is the first reported case of ARSA-esophageal fistula associated with prior esophagectomy and gastric pull-up. A MedLine search was performed for ARSA-esophageal fistula cases, which were then compared with the present case. Because this patient had no vascular conduits, nasogastric or endotracheal tubes, the fistula likely occurred secondary to the previous surgery. This case is unusual because the patient survived the original hemorrhage associated with the ARSA-esophageal fistula. An ARSA-esophageal fistula is a rare, but potentially fatal cause of upper gastrointestinal bleeding. A high index of suspicion is needed to make the diagnosis. This condition should be considered in patients with risk factors combined with hemodynamically significant gastrointestinal bleeding.
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Affiliation(s)
- Adam Millar
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario
| | - Alaa Rostom
- Division of Gastroenterology, The Ottawa Hospital, Ottawa, Ontario
| | - Pasteur Rasuli
- Division of Radiological Imaging, The Ottawa Hospital, Ottawa, Ontario
| | - Nav Saloojee
- Division of Gastroenterology, The Ottawa Hospital, Ottawa, Ontario
- Correspondence: Dr Nav Saloojee, Division of Gastroenterology, The Ottawa Hospital, Ottawa, Ontario. Telephone 613-737-8899 ext 76420, fax 613-737-8599, e-mail
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Roos D, Busch ORC, van Lanschot JJB. [Primary colon carcinoma in a colon interposition graft after oesophageal resection]. Ned Tijdschr Geneeskd 2007; 151:2111-2114. [PMID: 17948828] [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: 05/25/2023]
Abstract
A 79-year-old man presented with a massive subcutaneous swelling due to extreme dilatation ofa subcutaneously interposed right-sided hemicolon; 7 years earlier he had undergone oesophageal resection and gastric tube reconstruction for a poorly differentiated adenocarcinoma of the distal oesophagus. The procedure was complicated by gastric tube necrosis, and the tube was removed. One year later the continuity of the gastrointestinal tract was restored by a right-sided isoperistaltic colon graft: the terminal ileum, including the ileocecal valve, was anastomosed to the pre-existing cervical portion of the oesophagus. The dilatation was caused by an obstructive adenocarcinoma located in the distal part of the interposed colon in combination with an intact ileocecal valve in the neck. The tumour was a primary colon carcinoma with no evidence of further dissemination. The colon graft was removed, and the patient received a definitive salivary fistula placed in the neck and permanent feeding tube by jejunostomy. Development of primary colon carcinoma in a colon graft is rare; 7 cases have been reported in the literature so far. Routine endoscopic follow-up of a graft does not appear to be warranted, but endoscopy should be performed if symptoms arise.
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Affiliation(s)
- D Roos
- Academisch Medisch Centrum/Universiteit van Amsterdam, afd. Chirurgie, Amsterdam.
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Hanazono K, Natsugoe S, Okumura H, Matsumoto M, Oowaki T, Setoyama T, Hiraki Y, Arimura K, Nakamura F, Nakajo M, Aikou T. [An effective treatment by chemoradiation therapy after stent insertion for advanced esophageal cancer with esophago-pulmonary fistula--report of a case]. Gan To Kagaku Ryoho 2007; 34:1275-8. [PMID: 17687212] [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: 05/16/2023]
Abstract
We report the case of a 56-year-old male who was diagnosed as advanced esophageal cancer with esophago-pulmonary fistula and lung abscess. He received radiation therapy in combination with chemotherapy using cisplatin and 5-FU after insertion of a self-expanding metallic stent. He had sufficient food intake during the chemoradiotherapy (CRT). CRT was very effective for not only primary tumor but also lymph node metastasis, with resulting partial response. We could not detect any relapses and metastases for 8 months after CRT. The CRT after insertion of self-expanding metallic stent is one of the useful and palliative treatments for advance esophageal cancer with esophago-pulmonary fistula.
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Affiliation(s)
- Koichi Hanazono
- Dept. of Surgical Oncology and Digestive Surgery of Kagoshima University
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