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

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    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
    Issue Date
    2009
    MeSH
    Adenocarcinoma
    Aged
    Bronchial Fistula
    Esophageal Neoplasms
    Esophagectomy
    Gastric Fistula
    Humans
    Male
    Treatment Outcome
    
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    Citation
    Management of gastro-bronchial fistula complicating a subtotal esophagectomy: a case report. 2009, 9:20 BMC Surg
    Journal
    BMC surgery
    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
    ISSN
    1471-2482
    ae974a485f413a2113503eed53cd6c53
    10.1186/1471-2482-9-20
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