Two-stage Surgery for an Aortoesophageal Fistula Caused by Tuberculous Esophagitis

Shin, Hyun-Sik; Choi, Chang Woo; Lim, Jae Woong; Her, Keun

doi:10.3346/jkms.2015.30.11.1706

Cited by 9 publications

(5 citation statements)

References 10 publications

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“…While the proposed dual-stage approach requires two separate surgical interventions, the outcomes of this study suggest that the associated risk of graft degeneration/failure are fairly low and that the process results in an AMI with robust bidirectional signaling capabilities, potentially providing improved functionality for patients with amputation. There is precedent in the literature and in practice for various multi-step surgeries, including sympathectomies 28 , tumor resections 29 , fistula corrections 30 , and hip replacements 31 . Further, previous studies demonstrate that revision surgery in persons with amputation often promotes favorable outcomes including pain relief and improved motor function 3,32 .…”

Section: Discussionmentioning

confidence: 99%

Towards functional restoration for persons with limb amputation: A dual-stage implementation of regenerative agonist-antagonist myoneural interfaces

Srinivasan

Diaz

Carty

et al. 2019

Sci Rep

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While amputation has traditionally been viewed as a failure of therapy, recent developments in amputation surgery and neural interfacing demonstrate improved functionality and bidirectional communication with prosthetic devices. The agonist antagonist myoneural interface (AMI) is one such bi-directional neural communication model comprised of two muscles, an agonist and an antagonist, surgically connected in series within the amputated residuum such that contraction of one muscle stretches the other. By preserving agonist-antagonist muscle dynamics, the AMI allows proprioceptive signals from mechanoreceptors within both muscles to be communicated to the central nervous system. Preliminary human evidence suggests that AMIs have the capacity to provide high fidelity control of a prosthetic device, force feedback, and natural proprioception. However, AMIs have been implemented only in planned amputations and require healthy distal tissues, whereas the majority of amputations occur in patients who do not have healthy distal tissues. Through the use of a dual-stage surgical procedure which leverages existent tissues, this study proposes a revision model for implementation of the AMI in patients who are undergoing traumatic amputation or have already undergone a standard amputation. This paper validates the resulting AMI’s physiology, revealing robust viability and mechanical and electrophysiological function. We demonstrate the presence of H-waves in regenerative grafts, indicating the incorporation of the AMI into physiological reflexive loops.

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Section: Discussionmentioning

confidence: 99%

Towards functional restoration for persons with limb amputation: A dual-stage implementation of regenerative agonist-antagonist myoneural interfaces

Srinivasan

Diaz

Carty

et al. 2019

Sci Rep

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“…The main etiologic factors of AEF include aneurysm (54.2%), foreign body (19.2%) and esophageal cancer (17%)[ 7 , 8 ]. Other causes of AEF include radiotherapy[ 9 , 10 ] and infection[ 11 , 12 ].…”

Section: Discussionmentioning

confidence: 99%

Successful management of life-threatening aortoesophageal fistula: A case report and review of the literature

Zhong¹,

Li²

2022

WJCC

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BACKGROUND Aortoesophageal fistula (AEF) is a rare but life-threatening cause of upper gastrointestinal bleeding. Only a handful of cases of successful management of AEF caused by esophageal cancer have been reported. The purpose of this study is to report a case of AEF managed by endovascular aortic repair and review the relevant literature. CASE SUMMARY A 66-year-old man with upper gastroenterology bleeding presented at the Emergency Department of our hospital complaining of chest pain, fever and hematemesis for 6 h. He had vomited 400 mL of bright-red blood and experienced severe chest pain 6 h prior. He had a past medical history of advanced esophageal cancer. He received chemoradiotherapy but stopped 8 mo prior because of intolerance. A chest contrast computed tomographic scan revealed communication between the esophagus and the descending aorta as well as a descending aortic pseudoaneurysm. According to the symptoms and imaging findings, AEF was our primary consideration. The patient underwent aortic angiography, which indicated AEF and descending aortic pseudoaneurysm. Emergency percutaneous thoracic endovascular aortic repair (TEVAR) of the descending aorta was performed, and bleeding was controlled after TEVAR. He received antibiotics and was discharged after treatment. However, he died 2 mo after the TEVAR due to cancer progression. CONCLUSION Although AEF is a lethal condition, timely diagnosis and TEVAR may successfully control bleeding.

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“…The inability to advance the scope into the lumen of the stricture prevented us from taking biopsies from the culprit mucosa. In other cases, the histological confirmation is made following surgery with resection of the oesophageal stricture [ 9 , 10 ]. Once TB diagnosis is made, chest x-ray, abdominal ultra sound scan are done to rule out presence of TB in other areas.…”

Section: Discussionmentioning

confidence: 99%

“…Typically once the diagnosis is made, the patient is started on anti-TB medication and response has been described as sufficient [ 2 , 4 ]. However the presence of complications warrants surgical intervention [ 5 , 10 ] and this maybe in the form of treatment of the stricture following principles of stricture management. In our case, an Ivor-Lewis oesophagectomy was performed because of total oesophageal occlusion with suspicion of malignancy.…”

Section: Discussionmentioning

confidence: 99%

Tuberculosis as a primary cause of oesophageal stricture: a case report

Mbiine

Kabuye

Lekuya

et al. 2018

J Cardiothorac Surg

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BackgroundTuberculous (TB) oesophagitis is a rare manifestation of dysphagia occurring in 0.3% of all gastro-intestinal tract TB infections as well as 0.15% of all cases of dysphagia and often is misdiagnosed. This report presents a rare manifestation of TB as a cause of oesophageal stricture.Case presentationWe describe a rare presentation of a patient with grade IV dysphagia due to an oesophageal stricture. Oesophagoscopy revealed a pinhole stricture with evidence of high grade dysplasia on histology. Subsequently an Ivor-Lewis oesophagectomy was performed and histology revealed evidence of active oesophageal tuberculosis. The patient had an uneventful recovery and completed anti-TB medication.ConclusionsOesophageal TB is a rare but curable cause of dysphagia. It may mimic cancer of the oesophagus and it is usually missed as a possible cause of oesophageal strictures. There needs to be an increased index of suspicion among patients with dysphagia in TB endemic regions.

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Two-stage Surgery for an Aortoesophageal Fistula Caused by Tuberculous Esophagitis

Cited by 9 publications

References 10 publications

Towards functional restoration for persons with limb amputation: A dual-stage implementation of regenerative agonist-antagonist myoneural interfaces

Towards functional restoration for persons with limb amputation: A dual-stage implementation of regenerative agonist-antagonist myoneural interfaces

Successful management of life-threatening aortoesophageal fistula: A case report and review of the literature

Tuberculosis as a primary cause of oesophageal stricture: a case report

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