Tracheoinnominate fistula: surgical management of an iatrogenic disaster

2006 ◽  
Vol 120 (8) ◽  
pp. 676-680 ◽  
Author(s):  
R W Ridley ◽  
J B Zwischenberger
Keyword(s):  
Operating Room ◽  
Surgical Management ◽  
Surgical Repair ◽  
Surgical Intervention ◽  
Pectoralis Major Muscle ◽  
Muscle Flap ◽  
Rare Condition ◽  
Innominate Artery ◽  
Significant Potential ◽  
High Index Of Suspicion

Tracheoinnominate fistula (TIF) is a rare condition with significant potential for mortality if surgical intervention is not immediate. We present two cases of successfully managed TIF. Both cases involve ligation and resection of the innominate artery at the TIF followed by a pectoralis major muscle flap. In both cases, success was largely due to a high index of suspicion and immediate control of the bleeding with transport to the operating room for surgical repair. The history, aetiology, and pathogenesis of TIF are reviewed, yielding an algorithm for recommended management of TIF.

Children’s hand trauma

2011 ◽  
Author(s):  
Henk Giele
Keyword(s):  
Nerve Injury ◽  
Upper Limb ◽  
Growth And Development ◽  
Surgical Repair ◽  
Surgical Intervention ◽  
General Anaesthetic ◽  
Hand Trauma ◽  
Nail Bed ◽  
The Common ◽  
High Index Of Suspicion

♦ This chapter reinforces that children are not small adults and the management of these injuries must consider the effect on growth and development♦ Nail bed injuries require microsurgical repair if permanent deformity is to be avoided♦ Every attempt should be made to replace amputated digits, whatever the level of amputation♦ Good results are the common outcome in children’s fractures unless complicated by surgical intervention or infection. However, angulation, rotation, and intra-articular deformities should be corrected where possible♦ All children with deep lacerations of the upper limb should have a general anaesthetic for adequate exploration and repair of the wound♦ A high index of suspicion of nerve injury should exist when assessing hand lacerations, and the outcome of early surgical repair is good.

Slide Tracheoplasty in the Management of Congenital Tracheal Stenosis

1997 ◽  
Vol 106 (11) ◽  
pp. 914-919 ◽  
Author(s):  
Steven H. Dayan ◽  
Michael E. Dunham ◽  
Constantine Mavroudis ◽  
Carl L. Backer ◽  
Lauren D. Holinger
Keyword(s):  
Early Diagnosis ◽  
Tracheal Stenosis ◽  
Surgical Repair ◽  
Surgical Intervention ◽  
Rare Condition ◽  
Pericardial Patch ◽  
Congenital Tracheal Stenosis ◽  
Slide Tracheoplasty ◽  
Lost To Follow Up

Long-segment congenital tracheal stenosis (LSCTS) is a rare condition. Originally, it was felt to be uniformly fatal; however, advances in technique have made surgical repair and survival possible. Our objective is to report results and technique of slide tracheoplasty for the treatment of LSCTS in the context of the overall experience at the Children's Memorial Hospital in Chicago. We reviewed 37 cases of infants and children with LSCTS. Thirty of the 37 infants underwent surgical intervention. Slide tracheoplasty resulted in survival in 1 of 2 infants, and pericardial patch tracheoplasty resulted in survival in 21 of 28 (75%). Of the 30 patients who had surgical repair, 7 (23%) have died, and 1 has been lost to follow-up (3%). Follow-up has ranged from 6 months to 13 years. Slide tracheoplasty is a satisfactory adjunct to existing techniques. With early diagnosis and appropriate management of LSCTS, survival is possible in a majority of patients.

scholarly journals Cranio-vertebral junction tuberculosis

2012 ◽  
Vol 01 (01) ◽  
pp. 061-065 ◽  
Author(s):  
Keyword(s):  
Early Diagnosis ◽  
Surgical Intervention ◽  
Treatment Protocol ◽  
Case Series ◽  
Disease Process ◽  
Rare Condition ◽  
Craniovertebral Junction ◽  
Inflammatory Lesions ◽  
Malignant Lesions ◽  
High Index Of Suspicion

Abstract There are variety of diseases which affect the region of craniovertebral junction, including congenital, malignant lesions, traumatic and infective/inflammatory lesions. CVJ tuberculosis is an extremely rare condition, accounting for 0.3 to 1% of all cases of spinal TB. Few case series have been reported in the literature about this rare condition, but there appears to be lack of consensus even on basic issues like whether to undertake surgical intervention or prefer a conservative approach in cases of CVJ TB. These cases can present with a myriad of symptoms and one needs to have a high index of suspicion for early diagnosis. Early diagnosis and treatment is very important for a favorable outcome. In this article, we have tried to review the available literature and also share our experience about this condition so as to have a better understanding of the disease process and have a more rational treatment protocol.

PS01.101: SURGICAL MANAGEMENT OF ADULT ESOPHAGO-RESPIRATORY FISTULA: A TEN-YEAR EXPERIENCE.

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 78-78
Author(s):  
Inian Samarasam ◽  
Rajeevan Phillip ◽  
Roy Gnanamuthu ◽  
Vijay Abraham
Keyword(s):  
Multidisciplinary Approach ◽  
Surgical Intervention ◽  
Conflicts Of Interest ◽  
Muscle Flap ◽  
Rare Condition ◽  
Treatment Modalities ◽  
Esophageal Wall ◽  
Delayed Presentation ◽  
Subtotal Esophagectomy ◽  
Esophageal Stenting

Abstract Background Adult esophago-respiratory fistula is a rare condition, which is usually seen in malignancies or in benign conditions following trauma, infection or as a delayed presentation of congenitall tracheoesophageal fistula. They pose a technical challenge in stabilisation and management requiring multidisciplinary approach. Methods In this retrospective analysis of such cases over a period of ten years, who presented to our centre. The aetiology, presentation and treatment modalities were studied in detail. Of these,18 patients with benign esophago repiratory fistulae underwent surgical correction oft he same. This is discussed in detail. Results There were a total of 62 cases of adult esophago-respiratory fistula, over the 10 year period. Of the patients, 34 of the cases to be of malignant etiology and 28 of the cases to be of benign etiology such as prolonged tracheostomy, corrosive injury, infection, trauma or delayed presentation of congenital fistula. The mean age of presentation was 44 years. (range 18 to 81 years of age). There were 35 tracheoesophageal fistulae and 27 bronchoesophageal fistulae. Fourteen patients underwent esophageal stenting and 9 underwent tracheal stenting either as a temporary intervention to alleviate symptoms or as palliative intervention. Eighteen patients underwent definitive surgical intervention. Surgical repair involved approach through neck in 6 patients and thorax in 11 patients and a combination of both approaches in one patient. The esophageal end of the fistula was primarily closed or closed with the help of a pleural or pedicled muscle flap or a subtotal esophagectomy was performed. The respiratory end of the fistula was either primarily closed or with the help of a vascularized patch of the esophageal wall. The latter technique was used in four patients and is explained in detail. Conclusion Due to risk of fatal complications, early diagnosis, multidisciplinary approach and appropriate surgical intervention after nutritional build up is the key to successful management of adult esophago-respiratory fistula. Disclosure All authors have declared no conflicts of interest.

scholarly journals Gastrotracheal Fistula as a Result of Transhiatal Esophagectomy for Esophageal Cancer: An Unusual Complication

2015 ◽  
Vol 2015 ◽  
pp. 1-3
Author(s):  
Heshmatollah Salahi ◽  
Mehdi Tahamtan ◽  
Bijan Ziaian ◽  
Mansoor Masjedi ◽  
Zahra Saadati ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Distal Part ◽  
Surgical Repair ◽  
Surgical Intervention ◽  
Muscle Flap ◽  
Transhiatal Esophagectomy ◽  
Warning Signs ◽  
Fistula Tract ◽  
Unusual Complication ◽  
Cervical Anastomosis

Gastrotracheal fistula following open transhiatal esophagectomy (Orringer’s technique) for esophageal cancer is an unusual but lethal complication. Surgical intervention with resection of the fistula tract and primary interrupted suturing of gastric and tracheal orifices using a muscle flap interposition has proved to be a successful method. We report the case of a 73-year-old male with an adenocarcinoma of the distal part of the esophagus, who underwent open transhiatal esophagectomy (Orringer’s technique) with gastric tube reconstruction and cervical anastomosis. The patient did not receive induction chemoradiotherapy before the esophagectomy. Two attempts of surgical repair of fistula failed and the patient died. Being aware of warning signs such as dyspnea and respiratory distress accompanied by bilious content in the tracheal tube is helpful in the early detection and treatment of this type of fistula.

scholarly journals Salmonella Aortitis in an Elderly Male, a Rare but Deadly Cause of Abdominal Pain: A Case Report

2021 ◽  
Vol 2 (5) ◽  
pp. 242-245
Author(s):  
Kevin Yanushefski ◽  
Sukhdip Kaur ◽  
Mary Eberhardt
Keyword(s):  
Abdominal Pain ◽  
Case Report ◽  
Surgical Intervention ◽  
Rare Condition ◽  
Vascular Reconstruction ◽  
Elderly Male ◽  
Abdominal Ct ◽  
Diagnostic Modalities ◽  
High Level ◽  
High Index Of Suspicion

Introduction: Infectious aortitis is a rare condition with mortality rates approaching 100% without surgical intervention. Symptoms and findings may be vague. Computed tomography (CT) with intravenous (IV) contrast, once the gold standard of diagnosis, may only show subtle findings. More recently, CT angiography (CTA) and magnetic resonance angiography have become the diagnostic modalities of choice. Case Report: A 58-year-old diabetic male presented to our emergency department with nausea, vomiting, diarrhea, fevers, and abdominal pain of two weeks duration. The patient had been seen just days before at another facility with the same complaints. He received an abdominal CT with IV contrast that was reported as negative and discharged with the diagnosis of gastroenteritis. He failed to improve and presented to our facility. On presentation, the patient was diaphoretic and uncomfortable. A repeat abdominal CT with IV contrast revealed a mantle of low density around the aorta. The patient was started on IV antibiotics, and a follow-up CTA of the abdomen and pelvis showed an irregular saccular aneurysm. Vascular surgery was consulted, and the patient underwent vascular reconstruction. Conclusion: Because of the high level of mortality seen in infectious aortitis and improvement in patient outcomes with surgical intervention, a high index of suspicion needs to be maintained in patients presenting with fever and chest, abdominal, and back pain, especially in the setting of risk factors and bacteremia. The clinician should be aware that the usual modality for the evaluation of abdominal pain, CT with IV contrast, may not be adequate to make the diagnosis.

Surgical repair for tracheo-innominate artery fistula with a muscle flap

2003 ◽  
Vol 51 (11) ◽  
pp. 630-633 ◽  
Author(s):  
Yoshihiro Sawamura ◽  
Kei Takase ◽  
Norio Higuchi ◽  
Sekinori Kikuchi ◽  
Takashi Ito ◽  
...  
Keyword(s):  
Surgical Repair ◽  
Muscle Flap ◽  
Innominate Artery

Late Presentation of Penetrating Ulcers at the Ascending Aorta Associated With Intra-Mural Haematoma

2020 ◽  
Vol 3 (2) ◽  
pp. 01-05
Author(s):  
Ayman Kenawy
Keyword(s):  
High Risk ◽  
Disease Progression ◽  
Surgical Repair ◽  
Surgical Intervention ◽  
Late Presentation ◽  
Ascending Aorta ◽  
Chronic Type ◽  
Penetrating Aortic Ulcer ◽  
Good Outcome ◽  
Pseudo Aneurysm

The combined pathology of intra-mural haematoma (IMH) and penetrating aortic ulcer (PAU) represents disease progression of the PAU with high risk for further progression to either rupture or pseudo-aneurysm formation, and hence surgical intervention should be offered once diagnosis is made regardless of the presentation. We present a 70-year-old fit lady with chronic type A IMH associated with multiple PAUs, diagnosed incidentally, the patient underwent urgent surgical repair with good outcome.

Bone marrow necrosis and fat embolism syndrome: a near fatal complication in previously undiagnosed sickle beta + thalassaemia

2021 ◽  
Vol 14 (1) ◽  
pp. e238317
Author(s):  
Nibash Budhathoki ◽  
Sunita Timilsina ◽  
Bebu Ram ◽  
Douglas Marks
Keyword(s):  
Bone Marrow ◽  
Multiorgan Failure ◽  
Rare Condition ◽  
Altered Mental Status ◽  
Fat Embolism ◽  
Bone Marrow Necrosis ◽  
Embolism Syndrome ◽  
Hb S ◽  
High Index Of Suspicion ◽  
Specific Symptoms

Prevalence of haemoglobin sickle-β+ thalassaemia (Hb S/β+thal) is variable with geography ranging from 0.2% to 10% among sickle cell patients. Clinical presentation of Hb S/β+thal patients depends on HbA level, with milder disease often going undiagnosed. However, rarely these patients can present with a fulminant vaso-occlusive crisis (VOC). Given VOC can present with non-specific symptoms, the diagnosis and treatment is often delayed. Here, we present a patient who initially developed altered mental status, pancytopenia and multiorgan failure due a critical VOC resulting in bone marrow necrosis and fat embolism. Subsequent workup confirmed that our patient had Sickle-β+ thalassaemia, which had gone undiagnosed, despite subclinical evidence of haemolysis on routine lab work for years. Following diagnosis and initiation of RBC exchange, he improved significantly and was discharged home. High index of suspicion and bone marrow biopsy is vital for early diagnosis and management of this rare condition.

Intraorbital Abscess: A Rare Cause of Orbit Compression

FACE ◽  
2021 ◽  
pp. 273250162110050
Author(s):  
Samuel Ruiz ◽  
Rizal Lim
Keyword(s):  
Pediatric Population ◽  
Rare Complication ◽  
Disease Process ◽  
Rare Condition ◽  
External Drainage ◽  
Direct Extension ◽  
Life Threatening ◽  
History Of ◽  
High Index Of Suspicion ◽  
Prompt Diagnosis

Introduction: Intraorbital abscess is a rare complication of rhinosinusitis that affects most commonly the pediatric population. It is thought to be caused by direct extension or venous spread of infections from contiguous sites and can lead to life-threatening complications, like permanent visual loss and cerebral abscesses. Objectives: Intraorbital abscess is a rare condition that requires prompt diagnosis and treatment to avoid serious complications. Our objectives are to provide an overview of this rare disease process and its management including our successful treatment experience. Case Description: We present a 2 case report of a 13-year-old pediatric male and a 66-year-old male with history of chronic sinusitis who presented with a right intraorbital abscess successfully treated with external drainage with decompression of the orbit. Conclusion: When intraorbital abscess is encountered, a high index of suspicion is needed to allow prompt and accurate diagnosis for this infrequent condition. Timely surgical drainage of the abscess is needed to prevent the development of fatal complications.

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