Tracheopleural fistula after thoracoscopic esophagectomy: novel therapeutic approach with pericardial and intercostal muscle flaps

Rafieian, Shahab; Gharabaghi, Mehrnaz Asadi

doi:10.1093/jscr/rjy277

Cited by 6 publications

(9 citation statements)

References 2 publications

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“…There have been reports on using latissimus dorsi muscle and pericardial flap instead of intercostal muscle flap [ 9 , 10 ]; as the surgeon believed a tight closure is required for the fistula, the intercostal muscles was used instead of latissimus dorsi which is believed to be better for wide areas but not good to cover a fistula tightly [ 9 ]. Furthermore, although primary repair with pericardial flaps was reported, they are unsafe as they are poorly vascularised and can paradoxically move, mainly with positive pressure ventilation [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

A unique approach for a large intra-thoracic traumatic tracheo-oesophageal fistula: A case report from Syria

Darwish

Sikaria

Kakaje

2021

International Journal of Surgery Case Reports

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Introduction and importance Acquired tracheo-oesophageal fistula (TOF) is a rare complication of intubation or traumas, either blunt or penetrating. In a penetrating chest trauma, the closure of TOF can be challenging and requires a unique technique. A flap can and intra-tracheal tube can also be used. We present this case to demonstrate a unique late presentation of TOF and the unique approach that was used. Case presentation A patient presented with a large TOF caused by shrapnel, and was surgically managed after two months of the injury by using a smaller intra-tracheal tube, and using an oesophageal wall flap to close the tracheal defect and intercostal muscle flap was used for the oesophageal wall repair. The postoperative intrathoracic oesophageal leak was successfully treated conservatively. Clinical discussion Although the surgery could not be conducted until 2 months after the injury, the approach used was successful and the patient was able to resume his normal life after the surgery. The flap from the oesophagus and intercostal muscles and using a smaller tracheal tube successfully repaired the TOF with minimum stress on the suterings, and the conservative approach for the leak was also successful. Conclusion Traumatic TOF management can be complicated, but we speculate that using a smaller tube with the conservative management of the complications was ideal for the TOF acquired from a shrapnel.

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Section: Discussionmentioning

confidence: 99%

A unique approach for a large intra-thoracic traumatic tracheo-oesophageal fistula: A case report from Syria

Darwish

Sikaria

Kakaje

2021

International Journal of Surgery Case Reports

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“…Preoperative diagnosis by CT, intraoperative identification, and careful removal of the BCs under consideration of possible communication with the trachea is recommended. However, in the patients presenting with tracheal injury, primary closure or repair using the pericardial or intercostal muscle flap should be considered [13] .…”

Section: Clinical Discussionmentioning

confidence: 99%

Paratracheal air cyst and bronchogenic cyst in patients with esophageal cancer who received thoracoscopic esophagectomy: A case series of three patients

Okumura

Miwa

Watanabe

et al. 2021

International Journal of Surgery Case Reports

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Introduction and importance Mediastinal cystic lesions, such as paratracheal air cyst (PTAC) and bronchogenic cyst (BC), are rare anomaly usually found incidentally in thoracic imaging. Special attention is needed in the case of thoracic surgery. Case presentation All three patients were male, 71, 73, and 76 years old. Preoperative CT showed each had a lobular cystic lesion at the right posterolateral side of trachea in the thoracic outlet 11, 14, and 19 mm in size, respectively, with air density and tracheal communication, leading to a diagnosis of PTACs. An oval cystic lesion, 7 mm in size, was found in one patient at the right lateral side of the upper esophagus with low density and without tracheal communication, leading to a diagnosis of paraesophageal BC. Intraoperative findings of the three PTACs demonstrated a soft bulge from the membranous portion of trachea that was left intact. The BC had an oval elastic structure, mimicking a metastatic lymph node, and was removed with the mediastinal lymph nodes. Histological examination showed ciliated columnar epithelium, confirming a diagnosis of BC. Clinical discussion PTACs are associated with increased intraluminal pressure due to chronic lung disease. BCs are congenital anomalies that originate from abnormal budding of the embryonic foregut. Conclusion PTACs and BCs need to be considered in preoperative image diagnosis in patients with esophageal cancer. PTACs should be left intact to avoid tracheal injury, while removal of isolated BCs is recommended as a diagnostic and therapeutic measure.

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“…Many invasive airway and thoracic procedures can be complicated by iatrogenic tracheobronchial injuries, including endotracheal intubation, bronchoscopy, stent placement, and mediastinoscopy. Head and neck and esophageal surgical procedures may also result in iatrogenic tracheal injuries, with risk factors including previous malignancy, chemoradiation therapy, and extensive nodal dissection (10,11). Overall, the incidence of iatrogenic injury remains low but varies according to the procedure undertaken.…”

Section: Iatrogenic Injuriesmentioning

confidence: 99%

Imaging Evaluation of Tracheobronchial Injuries

2020

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Tracheobronchial injuries are a rare but potentially life-threatening cause of respiratory insufficiency, with high mortality rates. For patients with potentially survivable tracheobronchial injuries, imaging in the acute setting plays a key role in demonstrating the injuries and associated complications. The radiologist can improve outcomes by understanding typical injury patterns according to injury mechanism and the influence that imaging findings may have on treatment decisions. Chest radiography and cervical and thoracic CT are the mainstays of imaging in the acute setting and in follow-up, often as part of a whole-body trauma imaging series. The authors first consider the influence of normal tracheobronchial anatomy with regard to protective features, such as cartilaginous rings. They also discuss inherent points of vulnerability, such as points of relative fixation at the carina. A framework is then provided for understanding the typical distribution and morphology of tracheobronchial injuries according to cause. This includes penetrating, iatrogenic, and blunt force mechanisms, with consideration of potential complications. The authors highlight treatment strategies that require multidisciplinary collaboration, such as ventilation, minimizing injuries, and defining optimal surgical or nonsurgical treatment. ©

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Tracheopleural fistula after thoracoscopic esophagectomy: novel therapeutic approach with pericardial and intercostal muscle flaps

Cited by 6 publications

References 2 publications

A unique approach for a large intra-thoracic traumatic tracheo-oesophageal fistula: A case report from Syria

A unique approach for a large intra-thoracic traumatic tracheo-oesophageal fistula: A case report from Syria

Paratracheal air cyst and bronchogenic cyst in patients with esophageal cancer who received thoracoscopic esophagectomy: A case series of three patients

Imaging Evaluation of Tracheobronchial Injuries

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