P126 HIGH ESOPHAGOTRACHEAL FISTULA DURING STENT TREATMENT OF AN ANASTOMOTIC LEAKAGE AFTER ESOPHAGECTOMY

Aim We present a case of a 71 year old female with a combined anastomotic leakage after ivor-lewis resection and esophagotracheal perforation. Background & Methods Anastomotic leakage after esophageal resection is still associated with high morbidity and mortality throughout hospitalization. Nowadays there are several methods to accomplish sufficient closure of the anastomotic leakage such as clipping and using fibrin sealant in smaller leakages. Severe insufficiencies are commonly treated using esophageal stents. In our case the use of such a stent (10cm covered) placed to an anastomotic leak following esophagectomy with high intrathoracic anastomosis lead to an esophagotracheal fistula that was treated in a two-step approach. Firstly a tracheotomy was performed and the cuff of the tracheal cannula was blocked below the esophagotracheal fistula to prevent respiratory insufficiency. The stent was removed and an endosponge therapy was induced in order to manage the anastomotic leak. Finally, the semicircular wound could be covered by a fibrin sealant for final closure. In a second step, via open cervical surgery, the esophagotracheal fistula was resected, followed by overstitching of the pars membranacea and the esophagus and interposition of a muscle flap of the left pectoralis major muscle between trachea and esophagus. Results Postoperatively the patient was extubated with spontaneous breathing and the tracheal tube could be removed five days after surgery. After four days, the patient started drinking and enteral nutrition could be increased with a constant sufficiency of the gastric interponate. A postoperative contrast swallow at day 11 showed no leak and a good emptying of the gastric conduit. The control of the recurrent laryngeal nerves showed no abnormalities. Conclusion Our experience with endosponge treatment suggests that this is the first choice for successful healing of anastomotic leakage after ivor-lewis resection, especially in patients with a low BMI, to prevent esophageal stent perforations. Furthermore, the combination of an esophagotracheal fistula and an anastomotic leak does not have to result in a cervical outlet and removal of the gastric conduit. Patients should be delivered to specialized upper GI surgical centers, which have a high standard of complex esophageal surgery and endoscopic intervention possibilities.

Management of button batteries in the upper gastrointestinal tract of children

Background: To analyze the lodging locations of ingested button batteries in the upper gastrointestinal tract of children, common complications and treatment effects. Methods: The clinical data of 14 children with ingested button batteries lodged in the upper gastrointestinal tract were analyzed in our hospital between 2017 and 2019. Results: Among 10 children with ingested button batteries lodged in the first stenosis of esophagus, 9 were cured and 1 suffered from esophagotracheal fistula 12 days after removal. One child with the ingested button battery lodged in the second stenosis of esophagus was dead due to intercurrent aortoesophageal fistula 13 days after removal. Two cases had ingested button batteries lodged in the third stenosis of esophagus, and were cured after removal. The ingested button battery in 1 case was lodged in the gastrointestinal tract, and discharged spontaneously 1 day after hospital admission. Conclusions: Ingested button batteries are mainly lodged in the esophageal stenoses. Longer retention time could induce esophageal fistula. The ingested button battery in the gastrointestinal tract can discharge spontaneously.

Baby Death Due to Esophagotracheal Fistula Created by An Alkaline Battery: A Case Report

There is a limited number of case presentations in literature related to esophagus burns and complications as a result of swallowing an alkaline battery. The main purpose of this case presentation was to discuss the autopsy findings of late-developing complications of swallowing an alkali battery in the light of the relevant literature. On the chest radiography of a 9-month old baby with complaints of vomiting for three days, an opacity was observed consistent with a foreign body in the esophagus. Esophagoscopy was applied and the swallowed battery was removed. On the fifth day after the operation, no complication has been observed to oral feeding was started and on the following day the patient was discharged. Four days after discharge, the patient was again brought to hospital with complaints of blood in vomit and was again hospitalized with a diagnosis of chemical esophageal burn. The patient died on the following day....