BACKGROUND Tracheo and broncho esophageal fistulas and their potential complications in adults are seldom encountered in clinical practice but carries a significant morbidity and mortality.CASE SUMMARY We present a ca...BACKGROUND Tracheo and broncho esophageal fistulas and their potential complications in adults are seldom encountered in clinical practice but carries a significant morbidity and mortality.CASE SUMMARY We present a case of a 39-year-old otherwise healthy man who presented to our hospital after ingestion of drain cleaner substance during a suicidal attempt.He unexpectedly suffered from cardiac arrest during his stay in the intensive care unit.The patient had developed extensive segmental trachea-broncho-esophageal fistulous tracks that led to a sudden and significant aspiration event of gastric and duodenal contents with subsequent cardiopulmonary arrest.Endoscopic evaluation of extension of fistulous track proved a slow and delayed progression of disease despite initial management with esophageal stenting for his caustic injury.CONCLUSION The aim of this case presentation is to share with the reader the dire natural history of trachea-broncho-esophageal fistulas and its delayed progression.We aim to illustrate pitfalls in the endoscopic examination and provide further aware-ness on critical care monitoring and management strategies to reduce its morbidity and mortality.展开更多
We describe our experience of treatment for a giant esophageal malignant fistula, which has not been reported previously. A 36-year-old woman who was diagnosed as having massive esophageal small cell carcinoma with me...We describe our experience of treatment for a giant esophageal malignant fistula, which has not been reported previously. A 36-year-old woman who was diagnosed as having massive esophageal small cell carcinoma with metastases was treated with chemoradiotherapy. However, a giant esophagomediastinal fistula appeared due to shrinkage of the massive tumor, and all anti-cancer treatment was suspended. However, chemoradiotherapy was restarted at the request of the patient despite the presence of the fistula. After restarting treatment, the giant esophageal fistula was naturally closed despite intensive chemoradiotherapy, and the patient became able to eat and drink. Although the patient finally died, her QOL and prognosis seemed to be improved by the chemoradiotherapy. Anti-cancer treatment could be safely performed despite the presence of a giant fistula. The giant fistula closed while intensive chemotherapy was administered to the patient. Therefore, the presence of a fistula may not be a contraindication for curative chemoradiotherapy. Completion of treatment with proper management and maintenance of patients would be of benefit to patients with fistula.展开更多
BACKGROUND Fistulization is a rare complication of esophageal diverticula.Patients with this condition often require surgery,which unfortunately can be invasive and traumatic.Endoscopic therapy is an alternative metho...BACKGROUND Fistulization is a rare complication of esophageal diverticula.Patients with this condition often require surgery,which unfortunately can be invasive and traumatic.Endoscopic therapy is an alternative method for treating esophageal fistula.Hereby we introduce a new endoscopic technique that uses an esophageal pedicle flap to close esophageal fistulas.CASE SUMMARY A 49-year-old male patient,complaining of backache and choking,was formerly diagnosed with chronic bronchopneumonia.Chest computed tomography and esophagram confirmed the presence of esophageal diverticulum and mediastinal esophageal fistula.The patient was then treated by covering the fistulas using a pedicled flap that was acquired through endoscopic submucosal dissection of a patch from the proximal esophageal mucosa.Then the pedicle flap was reversed 180°to cover the fistula.Titanium clips were used to fix the flap.The procedure ended with percutaneous endoscopic gastrostomy for enteral nutrition.The patient was followed up to evaluate the size reduction of the fistula.Cough,backache,and fever were alleviated within a week.Forty-five days after the surgery,endoscopic examination showed that the fistulas were reduced in size.The larger one reduced from 0.5 cm to 0.2 cm,while the smaller one was fully closed.CONCLUSION Transplantation of a pedicle flap obtained from the esophageal mucosa endoscopically is minimally invasive for the treatment of fistula.展开更多
Objective： To find an effective treatment for advanced cancer patients with esophageal fistula. Methods： From 1998 to 2006, we studied 42 patients with advanced esophageal cancer and 5 lung cancer patients with carc...Objective： To find an effective treatment for advanced cancer patients with esophageal fistula. Methods： From 1998 to 2006, we studied 42 patients with advanced esophageal cancer and 5 lung cancer patients with carcinomatous esophageal fistula （3 females, 44 males, aged 29-92 years）. Ten patients with both esophageal cancer stricture and fistula were first dilated under endoscope, then a memory stent with a membrane was placed in the esophageal lumen. Others were treated only with a memory stent with a membrane, three of them with a large fistula （diameter 〉1.5 cm） were treated with bio-protein glue after placement of an esophageal metal stent. Results： The fistulas were covered by a stent and the patients could eat and drink immediately. Their quality of life was improved and their survival was prolonged, 44 out of 47 patients survived for 〉3 mo. Conclusion： Placement of esophageal stent with membrane or in combination with bio-protein glue through endoscope is an effective method for treating the bronchoesophageal fistula.展开更多
BACKGROUND Massive upper gastrointestinal(GI)bleeding is usually urgent and severe,and is mostly caused by GI diseases.Aortoesophageal fistula(AEF)after thoracic aortic stent grafting is a rare cause of this condition...BACKGROUND Massive upper gastrointestinal(GI)bleeding is usually urgent and severe,and is mostly caused by GI diseases.Aortoesophageal fistula(AEF)after thoracic aortic stent grafting is a rare cause of this condition,and has a poor prognosis with a high mortality rate.The clinical symptoms of AEF are usually nonspecific,and the diagnosis is often difficult,especially when upper GI bleeding is absent.Early identification,early diagnosis,and early treatment are very important for improving prognosis.CASE SUMMARY A 74-year-old man was admitted to the infectious disease department with>10-d fever and 10-mo prior history of thoracic aortic stent grafting for thoracic aortic penetrating ulcers.Blood tests revealed elevated inflammatory indicators and anemia.Chest computed tomography(CT)showed postoperative changes of the aorta after endovascular stent graft implantation,pulmonary infection and pleural effusion.Pleural effusion tests showed empyema.After 1 wk of anti-infective treatment,temperature returned to normal and chest CT indicated improvement in pulmonary infection and reduction of pleural effusion.Esophageal endoscopy was performed because of epigastric discomfort,and showed a large ulcer with blood clot in the middle esophagus.However,on day 11,hematemesis and melena developed suddenly.Bleeding stopped temporarily after hemostatic treatment and bedside endoscopic hemostasis.Thoracic and abdominal aortic CT angiography confirmed AEF.Later that day,he suffered massive hemorrhage and hemorrhagic shock.Eventually,his family elected to discontinue treatment.CONCLUSION AEF should be strongly considered in patients with a history of aortic intervention who present with fever,especially with empyema.展开更多
BACKGROUND Fistula between the esophagus and bronchial artery is an extremely rare and potentially life-threatening cause of acute upper gastrointestinal bleeding.Here,we report a case of fistula formation between the...BACKGROUND Fistula between the esophagus and bronchial artery is an extremely rare and potentially life-threatening cause of acute upper gastrointestinal bleeding.Here,we report a case of fistula formation between the esophagus and a nonaneurysmal right bronchial artery(RBA).CASE SUMMARY An 80-year-old woman with previous left pneumonectomy and recent placement of an uncovered self-expandable metallic stent for esophageal adenocarcinoma was admitted due to hematemesis.Emergent computed tomography showed indirect signs of fistulization between the esophagus and a nonaneurysmal RBA,in the absence of active bleeding.Endoscopy revealed the esophageal stent correctly placed and a moderate amount of red blood within the stomach,in the absence of active bleeding or tumor ingrowth/overgrowth.After prompt multidisciplinary evaluation,a step-up approach was planned.The bleeding was successfully controlled by esophageal restenting followed by RBA embolization.No signs of rebleeding were observed and the patient was discharged home with stable hemoglobin level on postoperative day 7.CONCLUSION This was a previously unreported case of an esophageal RBA fistula successfully managed by esophageal restenting followed by RBA embolization.展开更多
Background Advances in minimally invasive surgical techniques and neonatal intensive care for neonates have allowed for repair of the neonatal esophageal atresia with tracheoesophageal fistula （EA/TEF） to be approac...Background Advances in minimally invasive surgical techniques and neonatal intensive care for neonates have allowed for repair of the neonatal esophageal atresia with tracheoesophageal fistula （EA/TEF） to be approached endoscopically. However, thoracoscopic surgery in children is still performed in only a few centers throughout the world. The aim of this study was to compare the neonatal tolerance to the thoracoscopic repair （TR） and the open repair （OR） and also to discuss anesthetic management in thoracoscopic procedure. Methods We performed a prospective study enrolling newborns diagnosed with EA with distal TEF （type C） receiving the repair surgery between June 2009 and January 2012 in our institution. Data collected included the newborns＇ gestational age and weight at the time of the operation, operative time, parameters of intraoperative mechanical ventilation, oxygenation, end-tidal carbon dioxide （ETCO2）, and analysis of blood gases. Time to extubation and length of stay were also recorded. Results Intravenous induction with muscle paralysis followed by pressure-control ventilation and tracheal intubation regardless of the position of the fistula can be performed uneventfully in EA/TEF newborns with no additional airway anomalies and large, pericarinal fistulas in our experiences. The thoracoscopic approach appeared to take longer than the open approach. During the procedure of repair, hypercarbia and acidosis developed immediately 1 hour after pneumothorax in both groups. CO2 insufflation did have additional influence on the respiratory function of the newborns in the TR group; values of PaCO2 and ETCO2 were higher in the TR group but the difference did not reach statistical significance. By the end of the procedure, values of PaCO2 and ETCO2 returned to the baseline levels while pH did not, but all parameters made no difference in the two groups. Besides, time to extubation was shorter in the TR group. Conclusions Thoracoscopic repair of EA/TEF is comparable to the open repair, and is believed to be safe and tolerable in selected patients. A wider range of neonates may be acceptable for thoracoscopic EA/TEF repair with increasinQ surQical experience.展开更多
BACKGROUND Gastric pull-up(GPU)procedures may be complicated by leaks,fistulas,or stenoses.These complications are usually managed by endoscopy,but in extreme cases multidisciplinary management including reoperation m...BACKGROUND Gastric pull-up(GPU)procedures may be complicated by leaks,fistulas,or stenoses.These complications are usually managed by endoscopy,but in extreme cases multidisciplinary management including reoperation may be necessary.Here,we report a combined endoscopic and surgical approach to manage a failed secondary GPU procedure.CASE SUMMARY A 70-year-old male with treatment-refractory cervical esophagocutaneous fistula with stenotic remnant esophagus after secondary GPU was transferred to our tertiary hospital.Local and systemic infection originating from the infected fistula was resolved by endoscopy.Hence,elective esophageal reconstruction with freejejunal interposition was performed with no subsequent adverse events.CONCLUSION A multidisciplinary approach involving interventional endoscopists and surgeons successfully managed severe complications arising from a cervical esophagocutaneous fistula after GPU.Endoscopic treatment may have lowered the perioperative risk to promote primary wound healing after free-jejunal graft interposition.展开更多
We describe the case of a patient successfully reconstructed with laparoscopic retrosternal gastric pull-up after esophagectomy for unresectable posterior mediastinal inflammatory myofibroblastic tumor, eroding into t...We describe the case of a patient successfully reconstructed with laparoscopic retrosternal gastric pull-up after esophagectomy for unresectable posterior mediastinal inflammatory myofibroblastic tumor, eroding into the esophagus and compressing the airways. A partial esophagectomy with esophagostomy was performed for treatment of esophageal pleural fistula and empyema, while the airways were managed with the placement of an endobronchial stent. Gastrointestinal reconstruction was performed using a laparoscopic approach to create a retrosternal tunnel for gastric conduit pull-up and cervical anastomosis. The patient was discharged uneventfully after 6 d, and has done very well at home with normal diet.展开更多
文摘BACKGROUND Tracheo and broncho esophageal fistulas and their potential complications in adults are seldom encountered in clinical practice but carries a significant morbidity and mortality.CASE SUMMARY We present a case of a 39-year-old otherwise healthy man who presented to our hospital after ingestion of drain cleaner substance during a suicidal attempt.He unexpectedly suffered from cardiac arrest during his stay in the intensive care unit.The patient had developed extensive segmental trachea-broncho-esophageal fistulous tracks that led to a sudden and significant aspiration event of gastric and duodenal contents with subsequent cardiopulmonary arrest.Endoscopic evaluation of extension of fistulous track proved a slow and delayed progression of disease despite initial management with esophageal stenting for his caustic injury.CONCLUSION The aim of this case presentation is to share with the reader the dire natural history of trachea-broncho-esophageal fistulas and its delayed progression.We aim to illustrate pitfalls in the endoscopic examination and provide further aware-ness on critical care monitoring and management strategies to reduce its morbidity and mortality.
文摘We describe our experience of treatment for a giant esophageal malignant fistula, which has not been reported previously. A 36-year-old woman who was diagnosed as having massive esophageal small cell carcinoma with metastases was treated with chemoradiotherapy. However, a giant esophagomediastinal fistula appeared due to shrinkage of the massive tumor, and all anti-cancer treatment was suspended. However, chemoradiotherapy was restarted at the request of the patient despite the presence of the fistula. After restarting treatment, the giant esophageal fistula was naturally closed despite intensive chemoradiotherapy, and the patient became able to eat and drink. Although the patient finally died, her QOL and prognosis seemed to be improved by the chemoradiotherapy. Anti-cancer treatment could be safely performed despite the presence of a giant fistula. The giant fistula closed while intensive chemotherapy was administered to the patient. Therefore, the presence of a fistula may not be a contraindication for curative chemoradiotherapy. Completion of treatment with proper management and maintenance of patients would be of benefit to patients with fistula.
文摘BACKGROUND Fistulization is a rare complication of esophageal diverticula.Patients with this condition often require surgery,which unfortunately can be invasive and traumatic.Endoscopic therapy is an alternative method for treating esophageal fistula.Hereby we introduce a new endoscopic technique that uses an esophageal pedicle flap to close esophageal fistulas.CASE SUMMARY A 49-year-old male patient,complaining of backache and choking,was formerly diagnosed with chronic bronchopneumonia.Chest computed tomography and esophagram confirmed the presence of esophageal diverticulum and mediastinal esophageal fistula.The patient was then treated by covering the fistulas using a pedicled flap that was acquired through endoscopic submucosal dissection of a patch from the proximal esophageal mucosa.Then the pedicle flap was reversed 180°to cover the fistula.Titanium clips were used to fix the flap.The procedure ended with percutaneous endoscopic gastrostomy for enteral nutrition.The patient was followed up to evaluate the size reduction of the fistula.Cough,backache,and fever were alleviated within a week.Forty-five days after the surgery,endoscopic examination showed that the fistulas were reduced in size.The larger one reduced from 0.5 cm to 0.2 cm,while the smaller one was fully closed.CONCLUSION Transplantation of a pedicle flap obtained from the esophageal mucosa endoscopically is minimally invasive for the treatment of fistula.
文摘Objective： To find an effective treatment for advanced cancer patients with esophageal fistula. Methods： From 1998 to 2006, we studied 42 patients with advanced esophageal cancer and 5 lung cancer patients with carcinomatous esophageal fistula （3 females, 44 males, aged 29-92 years）. Ten patients with both esophageal cancer stricture and fistula were first dilated under endoscope, then a memory stent with a membrane was placed in the esophageal lumen. Others were treated only with a memory stent with a membrane, three of them with a large fistula （diameter 〉1.5 cm） were treated with bio-protein glue after placement of an esophageal metal stent. Results： The fistulas were covered by a stent and the patients could eat and drink immediately. Their quality of life was improved and their survival was prolonged, 44 out of 47 patients survived for 〉3 mo. Conclusion： Placement of esophageal stent with membrane or in combination with bio-protein glue through endoscope is an effective method for treating the bronchoesophageal fistula.
文摘BACKGROUND Massive upper gastrointestinal(GI)bleeding is usually urgent and severe,and is mostly caused by GI diseases.Aortoesophageal fistula(AEF)after thoracic aortic stent grafting is a rare cause of this condition,and has a poor prognosis with a high mortality rate.The clinical symptoms of AEF are usually nonspecific,and the diagnosis is often difficult,especially when upper GI bleeding is absent.Early identification,early diagnosis,and early treatment are very important for improving prognosis.CASE SUMMARY A 74-year-old man was admitted to the infectious disease department with>10-d fever and 10-mo prior history of thoracic aortic stent grafting for thoracic aortic penetrating ulcers.Blood tests revealed elevated inflammatory indicators and anemia.Chest computed tomography(CT)showed postoperative changes of the aorta after endovascular stent graft implantation,pulmonary infection and pleural effusion.Pleural effusion tests showed empyema.After 1 wk of anti-infective treatment,temperature returned to normal and chest CT indicated improvement in pulmonary infection and reduction of pleural effusion.Esophageal endoscopy was performed because of epigastric discomfort,and showed a large ulcer with blood clot in the middle esophagus.However,on day 11,hematemesis and melena developed suddenly.Bleeding stopped temporarily after hemostatic treatment and bedside endoscopic hemostasis.Thoracic and abdominal aortic CT angiography confirmed AEF.Later that day,he suffered massive hemorrhage and hemorrhagic shock.Eventually,his family elected to discontinue treatment.CONCLUSION AEF should be strongly considered in patients with a history of aortic intervention who present with fever,especially with empyema.
文摘BACKGROUND Fistula between the esophagus and bronchial artery is an extremely rare and potentially life-threatening cause of acute upper gastrointestinal bleeding.Here,we report a case of fistula formation between the esophagus and a nonaneurysmal right bronchial artery(RBA).CASE SUMMARY An 80-year-old woman with previous left pneumonectomy and recent placement of an uncovered self-expandable metallic stent for esophageal adenocarcinoma was admitted due to hematemesis.Emergent computed tomography showed indirect signs of fistulization between the esophagus and a nonaneurysmal RBA,in the absence of active bleeding.Endoscopy revealed the esophageal stent correctly placed and a moderate amount of red blood within the stomach,in the absence of active bleeding or tumor ingrowth/overgrowth.After prompt multidisciplinary evaluation,a step-up approach was planned.The bleeding was successfully controlled by esophageal restenting followed by RBA embolization.No signs of rebleeding were observed and the patient was discharged home with stable hemoglobin level on postoperative day 7.CONCLUSION This was a previously unreported case of an esophageal RBA fistula successfully managed by esophageal restenting followed by RBA embolization.
文摘Background Advances in minimally invasive surgical techniques and neonatal intensive care for neonates have allowed for repair of the neonatal esophageal atresia with tracheoesophageal fistula （EA/TEF） to be approached endoscopically. However, thoracoscopic surgery in children is still performed in only a few centers throughout the world. The aim of this study was to compare the neonatal tolerance to the thoracoscopic repair （TR） and the open repair （OR） and also to discuss anesthetic management in thoracoscopic procedure. Methods We performed a prospective study enrolling newborns diagnosed with EA with distal TEF （type C） receiving the repair surgery between June 2009 and January 2012 in our institution. Data collected included the newborns＇ gestational age and weight at the time of the operation, operative time, parameters of intraoperative mechanical ventilation, oxygenation, end-tidal carbon dioxide （ETCO2）, and analysis of blood gases. Time to extubation and length of stay were also recorded. Results Intravenous induction with muscle paralysis followed by pressure-control ventilation and tracheal intubation regardless of the position of the fistula can be performed uneventfully in EA/TEF newborns with no additional airway anomalies and large, pericarinal fistulas in our experiences. The thoracoscopic approach appeared to take longer than the open approach. During the procedure of repair, hypercarbia and acidosis developed immediately 1 hour after pneumothorax in both groups. CO2 insufflation did have additional influence on the respiratory function of the newborns in the TR group; values of PaCO2 and ETCO2 were higher in the TR group but the difference did not reach statistical significance. By the end of the procedure, values of PaCO2 and ETCO2 returned to the baseline levels while pH did not, but all parameters made no difference in the two groups. Besides, time to extubation was shorter in the TR group. Conclusions Thoracoscopic repair of EA/TEF is comparable to the open repair, and is believed to be safe and tolerable in selected patients. A wider range of neonates may be acceptable for thoracoscopic EA/TEF repair with increasinQ surQical experience.
文摘BACKGROUND Gastric pull-up(GPU)procedures may be complicated by leaks,fistulas,or stenoses.These complications are usually managed by endoscopy,but in extreme cases multidisciplinary management including reoperation may be necessary.Here,we report a combined endoscopic and surgical approach to manage a failed secondary GPU procedure.CASE SUMMARY A 70-year-old male with treatment-refractory cervical esophagocutaneous fistula with stenotic remnant esophagus after secondary GPU was transferred to our tertiary hospital.Local and systemic infection originating from the infected fistula was resolved by endoscopy.Hence,elective esophageal reconstruction with freejejunal interposition was performed with no subsequent adverse events.CONCLUSION A multidisciplinary approach involving interventional endoscopists and surgeons successfully managed severe complications arising from a cervical esophagocutaneous fistula after GPU.Endoscopic treatment may have lowered the perioperative risk to promote primary wound healing after free-jejunal graft interposition.
文摘We describe the case of a patient successfully reconstructed with laparoscopic retrosternal gastric pull-up after esophagectomy for unresectable posterior mediastinal inflammatory myofibroblastic tumor, eroding into the esophagus and compressing the airways. A partial esophagectomy with esophagostomy was performed for treatment of esophageal pleural fistula and empyema, while the airways were managed with the placement of an endobronchial stent. Gastrointestinal reconstruction was performed using a laparoscopic approach to create a retrosternal tunnel for gastric conduit pull-up and cervical anastomosis. The patient was discharged uneventfully after 6 d, and has done very well at home with normal diet.
