Management of gastro-bronchial fistula complicating a subtotal esophagectomy: a case report

Background  

The development of a fistula between the tracheobronchial tree and the gastric conduit post esophagectomy is a rare and often fatal complication.     

Emergency surgery for acute respiratory failure secondary to spontaneous thyroid hemorrhage

A 42-year-old woman was evaluated for an emergency at our surgical department for acute dyspnea associated with a spontaneous and rapidly enlarging mass of the neck. Clinical examination revealed a large, firm, nonfluctuant thyroid swelling on the right side of the neck. An urgent computerized tomography scan showed a hematoma within the right lobe of the thyroid and tracheal deviation with marked luminal narrowing. Because of the rapid progression of respiratory distress, endotracheal intubation by flexible laryngoscopy revealing normal vocal cords function and emergency total thyroidectomy were performed. During the operation, the thyroid gland showed a huge, edematous, nonfluctuant, rubbery, firm swelling with easy bleeding on touch, but the capsule appeared to be intact without rupture. Microscopic examination revealed a colloid multinodular goiter with massive parenchymal hemorrhage. Recovery was uneventful, and the patient was discharged 2 days after the operation.     

Airway gastric fistula after esophagectomy for esophageal cancer

Airway gastric fistula formation is a rare and complex complication after esophagectomy. Clinical presentations vary, making a uniform approach to treatment not possible. Recently, nonsurgical approaches have been reported using various types of airway stents. However, the usefulness of airway stenting in the treatment of airway gastric fistula is relatively unknown. We present a patient with hemoptysis, respiratory failure, and an enlarging left mainstem bronchogastric fistula after esophagectomy. The patient's symptoms were temporized by the placement of a silicone stent.     

Negative pressure ventilation for infants with respiratory failure after cardiac surgery

We report our experience using negative pressure ventilation (NPV) to support 40 infants who required prolonged positive pressure ventilation after cardiac surgery (average duration of post-operative positive pressure ventilation was 9.2 days). NPV was used for an average of 2.4 days, during which 20 patients were weaned to spontaneous unsupported ventilation, and 20 patients required reintubation. Progressive tachypnoea during NPV was a reliable sign of respiratory insufficiency and preceded failure of NPV. Patients who failed one trial of NPV were likely to fail later trials (11 of 13 failed repeated attempts at NPV). Complications following this therapy were minor. NPV may be successfully used as an alternative form of respiratory support for some infants who require prolonged positive pressure ventilation after cardiac surgery.     

Gastrotracheal fistula: a late complication after transhiatal esophagectomy

A 51-year-old woman underwent a transhiatal esophagectomy for a failed antireflux procedure. She did well for 15 months, when she developed evidence of hemoptysis followed by tracheogastric fistula. She underwent operative repair with the use of a pericardial patch to replace the membranous trachea and interposition of a latissimus dorsi flap to isolate the stomach from the tracheal suture line. She has done well after this operation.     

Gastric tube-to-pleural fistula seventeen months after esophagectomy

A gastric tube-to-pleural fistula is an uncommon late complication of esophagectomy. In this report, a 71-year-old man who developed gastric tube-to-pleural fistula 17 months after esophagectomy with intrathoracic reconstruction using a gastric tube is presented. Chest radiograph on admission showed massive right pleural effusion, which demonstrated empyema on chest drainage. Further imaging studies confirmed a gastric tube-to-pleural fistula that had no connection to the airway. We chose endoscopic intervention as a less invasive procedure and successfully treated the patient by plugging fibrin glue into the fistula under endoscopy. Review of the literature and discussion of the clinical features, differential causes, and treatment options of this rare and severe condition are presented.     

转移肌皮瓣修复食管癌切除术后早期胸胃气管瘘患者的护理

目的探讨食管癌根治术后早期发生胸胃气管瘘患者的护理方法及要点。方法回顾性分析3例食管癌术后发生胸胃气管瘘后行转移肌皮瓣修复术患者的护理过程。护理要点包括术后密切观察病情变化,尽早发现临床症状,积极配合急诊手术;加强皮瓣观察,注意引流管道及胸腔逆行冲洗护理,做好呼吸道管理及肠内营养支持,预防感染促进肌皮瓣成活,促进瘘口愈合;做好基础护理及心理护理。结果 3例患者经积极治疗护理均康复出院,随访3个月患者进食、呼吸正常。结论胸胃气管瘘是食管癌术后严重的并发症之一,急诊下行转移肌皮瓣修复术,术后加强专科护理,做好基础护理及心理护理可以降低患者病死率。     

Aortic valve papillary fibroelastoma that developed rapidly after open-heart surgery

The patient was a 76-year-old woman who underwent left atrial thrombectomy in November 2003 at our hospital. A mass adhered to the non-coronary aortic cusp was found during annual echocardiography, and the patient was admitted to our hospital. Transthoracic echocardiography detected two masses with pendulum-like movement: a 7-mm mass adhered to the non-coronary cusp and a 5-mm mass on the right coronary cusp. Papillary fibroelastoma was diagnosed based on the absence of inflammatory reactions or valvular destruction. Anticoagulant therapy was continued to prevent left atrial thrombus formation. At surgery, a 7-mm mass was adhered to the belly of the non-coronary cusp and a 5-mm pediculate mass was attached to a site near the nodule of Arantius of the right coronary cusp. Movable fibrous connective tissue 4 mm in length was present at two sites near the nodule of Arantius of the left coronary cusp, and these were also excised. All excised specimens, including those considered to be connective tissue, were found to be papillary fibroelastoma on pathological examination. Four papillary fibroelastomas that developed in all the cusps, including two small connective tissue-like morphologies and two sea anemone-like morphologies, indicated the process of papillary fibroelastoma growth and looked like 'a family'.     

Anesthetic management of a patient with lymphangioleiomyomatosis who developed respiratory failure post-operatively

A 34-year old female underwent lung biopsy under video assisted thoracoscopic surgery for lymphangioleiomyomatosis (LAM). She had obstructive lung disease, and had a large amount of ascites. We did not treat her lung disease pre-operatively because her pulmonary symptom was not severe. During operation, anesthesia was uneventful even during one lung ventilation period. After surgery, she showed hypoxemia and fell into respiratory failure. We suspect that respiratory failure was induced by ascites in this case. Respiratory failure would have come from restrictive ventilatory impairment caused by a large amount of ascites in addition to the obstructive ventilatory impairment. Care should be taken on respiratory function in case of LAM with ascites during perioperative period.     

A case report of treatment for tracheal fistula after radical esophagectomy

We report our experience of the treatment of a 60-year-old man with upper tracheal fistula which developed on the 11th day after radical surgery for esophageal cancer. Primary treatment to close the fistula was unsuccessful, resulting in the involvement of empyema due to infection. Controlled ventilation with T-tube and drainage through a chest tube for 2 months lead to depuration of the thoracic cavity. As a strategy for secondary closure of the fistula, fenestration was performed on the 87th day postoperatively. The patient's overall condition improved thereafter and closure was being considered. However, the patient died on the 116th day postoperatively due to supervenient aspiration pneumonia. Thus, long-term controlled ventilation with a T-tube was beneficial for the treatment of central airway injury.     

Mechanical ventilation for acute postoperative respiratory failure after surgery for bronchial carcinoma.

From 1978 to 1982 365 patients were treated surgically for bronchial carcinoma. Lobectomy was performed in 250 and pneumonectomy in 115. Sixteen (4.4%) needed mechanical ventilation for acute respiratory failure. Six out of eight with a lobectomy, but only two out of eight with a pneumonectomy, survived initially. Of these eight survivors, five died from recurrent malignancy within a year but three were alive and well at two years. The complications leading to acute respiratory failure were unpredictable in most patients. Improving techniques of mechanical ventilation and intensive care may lead to better results in the future.     

Disturbed anastomotic healing after esophagectomy: a novel treatment of a benign tracheo-neo-esophageal fistula

In this report a 65-year-old man is presented who developed a benign tracheo-neo-esophageal fistula 1 month after esophageal resection due to confined leakage of the cervical anastomosis. After unsuccessful conservative treatment, the fistula was partly excised via a cervical approach and a T-drain was inserted in the esophagus, thus creating a new fistula to the skin. Over a period of 8 weeks, the long mediastinal fistula track obliterated, and after removal of the T-drain the (neo-)esophagocutaneous fistula closed rapidly.     

Gastro-tracheal fistula - unusual and life threatening complication after esophagectomy for cancer: a case report

Background  

A gastro-tracheal fistula following esophagectomy for cancer is a rare but potentially lethal complication. We report the successful surgical closure after failed endoscopic treatment, of a gastro-tracheal fistula following esophago-gastrectomy for cancer after induction chemo-radiotherapy.     

Gastro-tracheal fistula - unusual and life threatening complication after esophagectomy for cancer: a case report

Purpose

The aim of this study is evaluate the efficacy of TachoSil^® patches in controlling suture-hole bleeding after elective infrarenal abdominal aortic aneurysm (AAA) replacement with Dacron graft.

Materials and methods

Patients undergoing elective replacement of infrarenal AAA with Dacron grafts were prospectively randomized to TachoSil^® patches (Group I) or standard compression with surgical swabs (Group II). We evaluated time to haemostasis, blood loss during the operation, blood loss after cross-clamp removal, duration of operation, drain volume, requirement for blood transfusion and surgeons rating of efficacy.

Results

Twenty patients were randomized (10 patients in each treatment Group). The mean time to haemostasis was 264 ± 127.1 s (range: 180-600 s) in Group I and 408 ± 159.5 s (range: 120-720 s) in Group II (p = 0.026); mean blood loss during the operation was 503.5 ± 20.7 cc (range: 474-545 cc) in Group I and 615.7 ± 60.3 cc (range: 530-720 cc) in Group II (p < 0.001); mean blood loss after cross-clamp removal was 26.5 ± 4 g (range: 22-34 g) in Group I and 45.4 ± 4.6 (range: 38-52 g) in Group II (p < 0.001) and mean drain volume was 116.7 ± 41.4 cc (range: 79-230 cc) in Group I and 134.5 ± 42.8 cc (range: 101-250 cc) in Group II (p = 0.034). There were no serious adverse events associated with use of TachoSil^® patches.

Conclusion

For patients undergoing aortic reconstruction with Dacron grafts, TachoSil^® patches were found to be safe and effective for the control of suture-hole bleeding.