Management of gastro-bronchial fistula complicating a subtotal esophagectomy: a case report.

Hdl Handle:
http://hdl.handle.net/10147/95035
Title:
Management of gastro-bronchial fistula complicating a subtotal esophagectomy: a case report.
Authors:
Martin-Smith, James D; Larkin, John O; O'Connell, Finbar; Ravi, Narayanasamy; Reynolds, John Vincent
Affiliation:
Department of Clinical Surgery, St James's Hospital and Trinity College Dublin, Dublin, Ireland. jmartins@tcd.ie
Citation:
Management of gastro-bronchial fistula complicating a subtotal esophagectomy: a case report. 2009, 9:20 BMC Surg
Journal:
BMC surgery
Issue Date:
2009
URI:
http://hdl.handle.net/10147/95035
DOI:
10.1186/1471-2482-9-20
PubMed ID:
20030856
Abstract:
BACKGROUND: The development of a fistula between the tracheobronchial tree and the gastric conduit post esophagectomy is a rare and often fatal complication. CASE PRESENTATION: A 68 year old man underwent radical esophagectomy for esophageal adenocarcinoma. On postoperative day 14 the nasogastric drainage bag dramatically filled with air, without deterioration in respiratory function or progressive sepsis. A fiberoptic bronchoscopy was performed which demonstrated a gastro-bronchial fistula in the posterior aspect of the left main bronchus. He was managed conservatively with antibiotics, enteral nutrition via jejunostomy, and non-invasive respiratory support. A follow- up bronchoscopy 60 days after the diagnostic bronchoscopy, confirmed spontaneous closure of the fistula CONCLUSIONS: This is the first such case where a conservative approach with no surgery or endoprosthesis resulted in a successful outcome, with fistula closure confirmed at subsequent bronchoscopy. Our experience would suggest that in very carefully selected cases where bronchopulmonary contamination from the fistula is minimal or absent, there is no associated inflammation of the tracheobronchial tree and the patient is stable from a respiratory point of view without evidence of sepsis, there may be a role for a trial of conservative management.
Language:
en
MeSH:
Adenocarcinoma; Aged; Bronchial Fistula; Esophageal Neoplasms; Esophagectomy; Gastric Fistula; Humans; Male; Treatment Outcome
ISSN:
1471-2482

Full metadata record

DC FieldValue Language
dc.contributor.authorMartin-Smith, James Den
dc.contributor.authorLarkin, John Oen
dc.contributor.authorO'Connell, Finbaren
dc.contributor.authorRavi, Narayanasamyen
dc.contributor.authorReynolds, John Vincenten
dc.date.accessioned2010-03-26T09:47:38Z-
dc.date.available2010-03-26T09:47:38Z-
dc.date.issued2009-
dc.identifier.citationManagement of gastro-bronchial fistula complicating a subtotal esophagectomy: a case report. 2009, 9:20 BMC Surgen
dc.identifier.issn1471-2482-
dc.identifier.pmid20030856-
dc.identifier.doi10.1186/1471-2482-9-20-
dc.identifier.urihttp://hdl.handle.net/10147/95035-
dc.description.abstractBACKGROUND: The development of a fistula between the tracheobronchial tree and the gastric conduit post esophagectomy is a rare and often fatal complication. CASE PRESENTATION: A 68 year old man underwent radical esophagectomy for esophageal adenocarcinoma. On postoperative day 14 the nasogastric drainage bag dramatically filled with air, without deterioration in respiratory function or progressive sepsis. A fiberoptic bronchoscopy was performed which demonstrated a gastro-bronchial fistula in the posterior aspect of the left main bronchus. He was managed conservatively with antibiotics, enteral nutrition via jejunostomy, and non-invasive respiratory support. A follow- up bronchoscopy 60 days after the diagnostic bronchoscopy, confirmed spontaneous closure of the fistula CONCLUSIONS: This is the first such case where a conservative approach with no surgery or endoprosthesis resulted in a successful outcome, with fistula closure confirmed at subsequent bronchoscopy. Our experience would suggest that in very carefully selected cases where bronchopulmonary contamination from the fistula is minimal or absent, there is no associated inflammation of the tracheobronchial tree and the patient is stable from a respiratory point of view without evidence of sepsis, there may be a role for a trial of conservative management.-
dc.language.isoenen
dc.subject.meshAdenocarcinoma-
dc.subject.meshAged-
dc.subject.meshBronchial Fistula-
dc.subject.meshEsophageal Neoplasms-
dc.subject.meshEsophagectomy-
dc.subject.meshGastric Fistula-
dc.subject.meshHumans-
dc.subject.meshMale-
dc.subject.meshTreatment Outcome-
dc.titleManagement of gastro-bronchial fistula complicating a subtotal esophagectomy: a case report.en
dc.contributor.departmentDepartment of Clinical Surgery, St James's Hospital and Trinity College Dublin, Dublin, Ireland. jmartins@tcd.ieen
dc.identifier.journalBMC surgeryen

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