Successful Endoscopic Treatment of a Postoperative Tracheomediastinal Fistula Caused by Anastomotic Insufficiency after Esophageal Resection with Fibrin Glue

2015 ◽  
Vol 86 (11) ◽  
Author(s):  
Guenter Weiss ◽  
Cora Wex ◽  
Hans Lippert ◽  
Jens Schreiber ◽  
Frank Meyer
Keyword(s):  
Fibrin Glue ◽  
Gastric Tube ◽  
Surgical Intervention ◽  
Esophageal Resection ◽  
Surrounding Tissue ◽  
Clinical Experiences ◽  
Anastomotic Insufficiency ◽  
Mediastinal Drainage ◽  
Inflammatory Changes ◽  
Tracheal Bifurcation

AbstractFistula development after esophageal resection is considered as one of the most serious postoperative complications.The authors reported a case on clinical experiences in the postoperative diagnostic and successful therapeutic management of a tracheomediastinal fistula after esophageal resection, using endoscopic application of fibrin glue.The early approach of an anastomotic insufficiency after esophageal resection because of a squamous cell carcinoma (pT3pN0M0G2) below the tracheal bifurcation including transposition of a re-modelled gastric tube and end-to-side anastomosis 24 hours postoperatively in a 55-year old patient combined i) surgical re-intervention from the periesophageal site (reanastomosis, gastroplication, lavage, local and mediastinal drainage) and, later on, ii) extensive rinsing with consecutive endoscopic fibrin glue application into the tracheal mouth of the subsequently developed tracheomediastinal fistula as a consequence of the inflammatory changes within the surrounding tissue.In conclusion, this approach was successful and beneficial for the patient's further postoperative course, which was associated with other complications such as pneumonia and acute myocardial infarction. The fistula closed sufficiently and permanently with no further surgical intervention at the tracheal as well as mediastinal site and allowed patient's later discharge with no further complaints or problems.

scholarly journals A giant femoral pseudo aneurysm secondary to arteriovenous fistula following stab injury

2016 ◽  
Vol 48 (1-2) ◽  
pp. 34-36
Author(s):  
Proshanta Kumar Biswas ◽  
Milton Mallick ◽  
Sunil Kumar Biswas
Keyword(s):  
Arteriovenous Fistula ◽  
Vascular Tissue ◽  
Surgical Intervention ◽  
Left Thigh ◽  
Surrounding Tissue ◽  
Stab Injury ◽  
Pulsatile Mass ◽  
Aneurysm Wall ◽  
Pseudo Aneurysm ◽  
Organized Thrombus

Pseudo aneurysm wall is not formed by vascular tissue but develops from organized thrombus, associated fibrosis and surrounding tissue. Post stab injury pseudo aneurysm associated with arteriovenous fistula of lower limb is exceptional. Here one such case is reported who was operated 4 months after the incidence of stab injury in his way back home at an incidence of robbery. The patient was very poor and did not have the ability to seek higher medical care. He was moving everywhere with a big pulsatile mass on supero medial part of his left thigh. Lastly surgical intervention was done and the patient got well.Bang Med J (Khulna) 2015; 48 : 34-36

scholarly journals Instruments Used in Skin Incision

2018 ◽  
Vol 2 (3) ◽  
pp. 557-561
Author(s):  
Bárbara Cartes ◽  
Leonardo Brito ◽  
Juan Alister ◽  
Francisca Uribe ◽  
Sergio Olate
Keyword(s):  
Postoperative Infection ◽  
Surgical Intervention ◽  
Skin Incision ◽  
Repair Time ◽  
Surrounding Tissue ◽  
Cosmetic Results ◽  
Conventional Instrumentation

The incision is the beginning of every surgical intervention, where separation of the tissues occurs. The uses of thermal mechanisms in skin incisions have been controversial due to higher repair time, necrosis of surrounding tissue, postoperative infection, and poor cosmetic results. The purpose of this study was to determine the evolution of the various types cutting systems and compare the tissue’s response on the use of conventional instrumentation versus diathermy

PS01.110: ACUTE NECROTIZING ESOPHAGITIS WITH ESOPHAGUS PERFORATION, TREATED BY THORACOSCOPIC ESOPHAGECTOMY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 81-81
Author(s):  
Ryujiro Akaishi ◽  
Yusuke Taniyama ◽  
Tadashi Sakurai ◽  
Takahiro Heishi ◽  
Hiroshi Okamoto ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Conflicts Of Interest ◽  
Esophageal Resection ◽  
Endoscopic Examination ◽  
Resected Specimen ◽  
Thoracic Esophagus ◽  
Esophageal Mucosa ◽  
Acute Necrotizing ◽  
Esophagus Perforation ◽  
Black Pigmentation

Abstract Background Acute necrotizing esophagus is defined as the diffuse black pigmentation of the esophagus due to the necrosis of the esophageal mucosa, and so called ‘black esophagus’ from its endoscopic findings. The prevalence is only 0.001∼0.2%, although the mortality rate is up to 32%. Methods 67 years old female with medical history of diabetes mellitus, transported to the emergency room with hematemesis and conscious disorder. She had suffered from nausea and epigastralgia for two days. Her general status was in shock vitals and didn’t respond to rehydration. After intubation, emergency endoscopic examination revealed black pigmentation of the esophageal mucosa and diagnosed as acute necrotizing esophagitis. Antibiotics and blood absorption therapy had been started and the patient gradually stabilized. 1 week after the admission, esophagus perforation was suspected from the significant increase of the right pleural effusion and free air at the esophagus wall and the mediastinum on CT scan. Emergency thoracoscopy was performed and found that the esophagus was edematous and adventitia was colored into black. The esophagectomy with esophagostomy and enterostomy was performed. Results On resected specimen, mucosal necrosis was found only on squamous epithelium with three perforating areas in the middle to lower thoracic esophagus. No signs of inflammation nor ischemia was found on the gastric mucosa of the esophagogastric junction. After the operation, patient recovered generally well, except the severe stenosis of the cervical esophagus had developed. Although endoscopic dilation had been constantly performed, the reconstruction remains unsolved issue. Conclusion In acute necrotizing esophagitis, stabilization of the patient's condition by treating comorbid diseases is extremely important. Improving the nutritional status in addition to the administration of antacids and antibiotics is also required. Surgical intervention should be performed when perforating mediastinitis or abscess formation occurs. Primary closure shouldn’t be attempted, and esophageal resection with delayed reconstruction should be considered in addition to drainage. In this case, we could successfully rescued the patient with necrotic esophagitis by performing surgical intervention promptly. It is important to detect the esophagus perforation and mediastinitis early, not to miss the chance of surgical intervention for curative treatment. Disclosure All authors have declared no conflicts of interest.

An exceptional postoperative gastric tube bleeding after esophageal resection for cancer

2009 ◽  
Vol 22 (5) ◽  
pp. E11-E13 ◽  
Author(s):  
Davide Di Mauro ◽  
Leopoldo Sarli ◽  
Luigi Roncoroni
Keyword(s):  
Gastric Tube ◽  
Esophageal Resection

Fundus Rotation Gastroplasty vs. Kirschner-Akiyama Gastric Tube in Esophageal Resection: Comparison of Perioperative and Long-Term Results

2008 ◽  
Vol 32 (8) ◽  
pp. 1695-1702 ◽  
Author(s):  
Werner Hartwig ◽  
Oliver Strobel ◽  
Lutz Schneider ◽  
Thilo Hackert ◽  
Christine Hesse ◽  
...  
Keyword(s):  
Gastric Tube ◽  
Esophageal Resection ◽  
Long Term Results

scholarly journals Application of Mediastinal Drainage Tube in Intrathoracic Esophageal Anastomotic Leakage for Early Diagnosis and Effective Treatment: A Retrospective Study

2020 ◽  
Author(s):  
Hainong Ma ◽  
Xu Song ◽  
Jie Li ◽  
Guofang Zhao
Keyword(s):  
Early Diagnosis ◽  
Anastomotic Leakage ◽  
Esophageal Resection ◽  
Drainage Tube ◽  
Control Group ◽  
Common Symptom ◽  
Pleural Drainage ◽  
Significant Difference ◽  
Mediastinal Drainage ◽  
Almost All

Abstract Background: Intrathoracic esophageal anastomotic leakage (AL) is one of the most fatal complications after esophagectomy. In this study, we tried to place an additional drainage tube in esophagus bed and evaluate its effect in early diagnosis and treatment of AL.Methods: From January 2010 to August 2020, a total of 312 patients, who suffered from esophageal or cardia carcinoma, underwent esophageal resection with intrathoracic esophagogastric anastomosis. Among them, we identified 138 patients with only one pleural drainage tube as “Control Group” and 174 patients with a pleural drainage tube and an additional mediastinal drainage tube (MDT) as “Tube Group”. The incidence of postoperative AL, time to diagnosis, time to recovery, and patient outcome were analyzed.Results: There were no significant differences in the AL rate (P = 0.837) and postoperative pain between two groups. However, in the Tube Group, almost all the patients were definitely diagnosed prior to the appearance of hyperpyrexia, which was regarded as the earliest and most common symptom after AL. Moreover, in the Tube Group, there was significant decrease in the incidence of uncurable fistula, which required re-operation or variable treatments under gastroscopy, when compared to the Control Group (P = 0.032). Finally, patients in the Tube Group were associated with reduced post AL hospital day (P = 0.015) and lower mortality, although there was no significant difference (P = 0.188), than in the Control Group.Conclusions: Placement of a MDT can not prevent the AL, but it is an effective method to diagnose AL earlier and facilitate the fistula healing and patient recovery.

scholarly journals Gastric Tube-Pulmonary Fistula after Esophageal Reconstruction Treated by Endoscopic Fibrin Glue Injection: A Case Report.

2001 ◽  
Vol 34 (4) ◽  
pp. 329-333 ◽  
Author(s):  
Masashi Hanai ◽  
Youichiro Kobayashi ◽  
Kanji Miyata ◽  
Fumihiko Yoneyama ◽  
Tatsuo Hattori ◽  
...  
Keyword(s):  
Case Report ◽  
Fibrin Glue ◽  
Gastric Tube ◽  
Esophageal Reconstruction ◽  
Glue Injection

Deep cervical and paratracheal drainage for descending necrotizing mediastinitis

2019 ◽  
Vol 28 (1) ◽  
pp. 29-32 ◽  
Author(s):  
Takashi Sakai ◽  
Noriyuki Matsutani ◽  
Ken Ito ◽  
Masato Mochiki ◽  
Joji Mineda ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Primary Treatment ◽  
Descending Necrotizing Mediastinitis ◽  
Transcervical Approach ◽  
Efficacious Treatment ◽  
Mediastinal Drainage ◽  
Life Threatening ◽  
Fluid Collections ◽  
Upper Mediastinum ◽  
Spread Of Infection

Background Descending necrotizing mediastinitis is life-threatening and extends into the deep cervical fascia including the pretracheal, perivascular and retrovisceral, and prevertebral spaces. Deep cervical and paratracheal drainage via a transcervical approach prevents the spread of infection into the deep mediastinum. It is effective for local neck drainage and important in the primary treatment of descending necrotizing mediastinitis. Transthoracic mediastinal drainage is also effective for treating this condition. Methods Nine patients with descending necrotizing mediastinitis were treated by deep cervical and paratracheal drainage via a transcervical approach at our institution from April 2007 to December 2017. Four patients with diagnoses of extensive descending necrotizing mediastinitis had progressive extension of abscesses into the lower mediastinum, below the level of the carina. The other five had localized descending necrotizing mediastinitis with infection in the upper mediastinum above the level of the carina. Results All 9 patients (4 with extensive and 5 with localized descending necrotizing mediastinitis) initially underwent deep cervical and paratracheal drainage via a transcervical approach, and all recovered. Two of the patients with extensive infection required no additional surgical intervention. Conclusions Fluid collections in the deep cervical fascia must be drained urgently. Deep cervical and paratracheal drainage via a transcervical approach effectively controls all types of descending necrotizing mediastinitis, and it is less invasive than transthoracic approaches via thoracotomy. However, a thoracotomy for mediastinal drainage must be considered if infection is not controlled by transcervical drainage. Thoracic surgeons and otolaryngologists must plan efficacious treatment before surgical procedures for descending necrotizing mediastinitis.

PS01.208: SURVEY ON THE MANAGEMENT OF ANASTOMOTIC LEAKAGE AFTER ESOPHAGEAL RESECTION WITH GASTRIC TUBE RECONSTRUCTION

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 108-109
Author(s):  
Eliza Hagens ◽  
Maarten Anderegg ◽  
Mark I Van Berge Henegouwen ◽  
Suzanne Gisbertz
Keyword(s):  
Anastomotic Leakage ◽  
Gastric Tube ◽  
Locally Advanced ◽  
Treatment Guideline ◽  
Esophageal Resection ◽  
Esophageal Surgery ◽  
International Guideline ◽  
Radio Therapy ◽  
First Choice ◽  
Gastric Tube Reconstruction

Abstract Background For patients with locally advanced esophageal cancer, radical esophageal resection with gastric tube reconstruction preceded by chemo(radio)therapy offers the best chance for cure. Anastomotic leakage (AL) is one of the most severe complications following esophageal surgery, leading to significant morbidity, prolonged hospital stay, considerable costs, decreased quality of life and increased mortality. Management is complicated and not standardized. The objective is to gain insight into the different opinions on AL management among upper gastrointestinal surgeons and to verify the need for a diagnostic and treatment guideline. Methods Surgeons with particular interest in esophageal surgery, were invited to participate in an online questionnaire. The survey consisted of questions pertaining to the surgeons’ experience, operation characteristics, management routine and their opinion on international guidelines on the diagnosis and therapy of AL. Results Of the 331 invited physicians, 40% participated in the survey. 90.7% Use laboratory diagnostics and 62.8% imaging and/or endoscopy postoperatively on routine basis. In case of suspected AL, the first choice of diagnostic imaging modalities was mostly a CT scan (35.7%) or a dynamic swallow investigation (33.3%). In case of AL, indepently of the clincal manifestations (local symptoms only, medianstinal manifestations or In case of gastric conduit necrosis) the treatment strategies differed widely between surgeons (table 1). Over 70% of the responders agree that there is a need for a solid international guideline on AL management. Conclusion There is no general consensus in the management of AL. There is a need for an international guideline regarding the optimal management of AL. Disclosure All authors have declared no conflicts of interest.

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