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

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 dr...

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Autores principales: Martin-Smith, James D, Larkin, John O, O'Connell, Finbar, Ravi, Narayanasamy, Reynolds, John Vincent
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2009
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2803445/
https://www.ncbi.nlm.nih.gov/pubmed/20030856
http://dx.doi.org/10.1186/1471-2482-9-20
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author Martin-Smith, James D
Larkin, John O
O'Connell, Finbar
Ravi, Narayanasamy
Reynolds, John Vincent
author_facet Martin-Smith, James D
Larkin, John O
O'Connell, Finbar
Ravi, Narayanasamy
Reynolds, John Vincent
author_sort Martin-Smith, James D
collection PubMed
description 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.
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spelling pubmed-28034452010-01-09 Management of gastro-bronchial fistula complicating a subtotal esophagectomy: a case report Martin-Smith, James D Larkin, John O O'Connell, Finbar Ravi, Narayanasamy Reynolds, John Vincent BMC Surg Case report 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. BioMed Central 2009-12-24 /pmc/articles/PMC2803445/ /pubmed/20030856 http://dx.doi.org/10.1186/1471-2482-9-20 Text en Copyright ©2009 Martin-Smith et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case report
Martin-Smith, James D
Larkin, John O
O'Connell, Finbar
Ravi, Narayanasamy
Reynolds, John Vincent
Management of gastro-bronchial fistula complicating a subtotal esophagectomy: a case report
title Management of gastro-bronchial fistula complicating a subtotal esophagectomy: a case report
title_full Management of gastro-bronchial fistula complicating a subtotal esophagectomy: a case report
title_fullStr Management of gastro-bronchial fistula complicating a subtotal esophagectomy: a case report
title_full_unstemmed Management of gastro-bronchial fistula complicating a subtotal esophagectomy: a case report
title_short Management of gastro-bronchial fistula complicating a subtotal esophagectomy: a case report
title_sort management of gastro-bronchial fistula complicating a subtotal esophagectomy: a case report
topic Case report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2803445/
https://www.ncbi.nlm.nih.gov/pubmed/20030856
http://dx.doi.org/10.1186/1471-2482-9-20
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