CHILAIDITI SYNDROME VS PNEUMOPERITONEUM: THE DIAGNOSTIC DILEMMA

BACKGROUND: Chilaiditi sign is an uncommon illness characterized by radiological evidence of colonic interposition between the liver and the diaphragm or abdominal wall. This is often confused with the pneumoperitoneum; hence it is important to differentiate the two entities as former is managed conservatively whereas latter requires surgical intervention. This case reports aims to highlight the dilemma faced by the physicians in the emergency room between the two entities.

Colonic interposition for oesophageal replacement surgery in a patient with left broncho-oesophageal fistula: anaesthetic management

Management of an uncorrected broncho-oesophageal fistula in the perioperative period is a challenge for the anaesthesiologist. Positive pressure ventilation which is inevitable during surgery will lead to gastric insufflation and there is a high risk of aspiration of gastric contents. In this case report, we discuss how we used a double lumen tube to occlude a pericarinal broncho-oesophageal fistula. This method was quite effective as it obviated the need for isolating the lung as well as ensured smooth delivery of positive pressure ventilation during the surgery.

Colonic interposition for recurrent Gastroesophageal junction adenocarcinoma of stomach: a case report

Introduction: Gastric cancer is a major cause of cancer death worldwide. Potential curative treatment for gastric cancer is radical gastrectomy. The reasons for local recurrence could be many like inadequate margin at the time of resection, biology of the disease, bad patient compliance. Esophagogastrectomy with colonic interposition may be required in case of distal esophageal carcinoma, carcinoma of proximal stomach and also in esophagogastric anastomotic recurrence, especially when the stomach is not suitable or available. Case description: A 30-year-old female, who had undergone proximal partial gastrectomy about 14 months back for poorly differentiated mucinous adenocarcinoma of stomach, was admitted with a 20 days history of dysphagia which was initially for solid food but later progressed causing difficulty in swallowing liquid as well. In past 14 months patient had undergone 6 cycles of chemotherapy. Transhiatal esophagectomy with interposition of right colon with terminal ileum with end to end anastomosis of oesophagus and ileal ends followed by colojejunostomy and ileocolostomy with FJ placement. Conclusion: When enough stomach remains it can be used as an esophageal replacement. However, when the stomach cannot be used due to more extensive primary disease or like in this case, needs to be resected due to recurrence of the disease, the interposed colon or jejunum needs to be used for esophageal reconstruction.

Unusual complication of colonic carcinoma: colonopleurobronchial fistula

Colonopleurobronchial fistula (CPBF) is a rare complication which occurs due to diversified causes. Expectoration of the faecal material is the classical clinical symptom which suggests the diagnosis. Various causes include infection of pulmonary or abdominal origin, inflammatory bowel disease, colonic malignancy, diaphragmatic hernia and colonic interposition. Crohn’s disease is the frequent underlying pathology, colonic malignancy accounts for rare cause. Due to the presence of liver in right upper quadrant, most of the fistulas are on the left side. Here we describe a rare case of a 38-year-old man presented with right-sided CPBF due to underlying colonic malignancy. Bronchial block was done, however the patient succumbed to death.

Comparison of Preoperative CT Colonography and Colonoscopy for Esophageal Reconstruction with Colonic Interposition

Colonic evaluation is an essential step before proceeding with esophagectomy to reconstruct by colonic interposition. Colonoscopy is the standard practice for colorectal cancer screening, but it has a chance of failing cecal intubation and carries a risk of horrific adverse events by colonic perforation. CT colonography is a less invasive alternative method reported as useful for colonoscopic screening in cases of average risk of colorectal cancer. This study set out to report our clinical experience and to evaluate CT colonography in the preoperative process for colonic interposition of esophagectomy patients. Data for esophagectomy with colonic interposition patients were retrospectively analyzed and compared the colonoscopy group with the CT colonography group. During eight years, 31 patients, 12 patients in the colonoscopy group and 19 patients in the CT colonography group, included in this study. In both groups, the patient demographic data, procedures, and outcomes were not different. After colonic interposition, endoscopy was performed, and no lesions of conduits were detected. CT colonography is a minimally invasive and reliable option for colonic evaluation method for the patient of average colorectal cancer risk who has undergone esophagectomy with colonic interposition.