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Laparotomy enables retrograde dilatation and stent placement for malignant esophago-respiratory fistula.

Rehders A, Cupisti K, Schmitt M, Renter MA, Kröpil P, Iskender O, Knoefel WT - World J Surg Oncol (2008)

Bottom Line: Using a guidewire the esophageal obstruction was traversed and dilated.Then it was possible to place an esophageal stent via an antegrade approach.Open surgery enables a safe access for retrograde endoscopic therapy in patients who had undergone esophageal resection with gastric interposition.

View Article: PubMed Central - HTML - PubMed

Affiliation: Klinik für Allgemein-, Viszeral- und Kinderchirurgie, Heinrich Heine Universität, Düsseldorf, Germany. rehders@med.uni-duesseldorf.de

ABSTRACT

Background: Malignant esophageal stenosis with complete obstruction and esophagorespiratory fistula (ERF) is difficult to treat with standard endoscopic techniques.

Case presentation: We report a patient in whom with local recurrence of esophageal carcinoma an esophagotracheal fistula occurred. Initially the patient had undergone esophageal resection with interposition of a gastric tube. Due to complete obstruction of the lumen by recurrent tumor conventional transoral stent placement failed. For retrograde dilatation a laparotomy was performed. Via a duodenal incision endoscopic access to the gastric tube was achieved. Using a guidewire the esophageal obstruction was traversed and dilated. Then it was possible to place an esophageal stent via an antegrade approach.

Conclusion: Open surgery enables a safe access for retrograde endoscopic therapy in patients who had undergone esophageal resection with gastric interposition.

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Axial contrast enhanced CT image showed a mediastinal tumor with mediastinal air and a perforation of the tracheal wall (arrow).
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Figure 1: Axial contrast enhanced CT image showed a mediastinal tumor with mediastinal air and a perforation of the tracheal wall (arrow).

Mentions: A 66-year-old man presented with severe dysphagia, weight loss and recurrent pulmonary infections due to an esophago-tracheal fistula. Due to squamous cell carcinoma of the esophagus 17 month ago, he had undergone esophageal resection and interposition of a gastric tube with cervical anastomosis. This treatment was followed by adjuvant radio-chemotherapy (50 Gy with 5-FU and Cisplatin). The first signs of dysphagia developed 8 weeks before admission to our hospital. Initial endoscopic therapy revealed local tumor recurrence beginning at 21 cm from front incisors, but failed to provide palliation of dysphagia. The distal end of the stenosis could not be measured precisely due to high grade stenosis which could not be passed endoscopically. Though intravenous hyperalimentation was administered, the patient kept on losing weight. Furthermore recurrent pulmonary infections occurred and swallowing of salvia, without coughing became impossible. For palliative surgical treatment the patient was transferred to our institution. Unfortunately we found the esophageal lumen to be completely obstructed by recurrent tumor. Moreover the tumor had invaded the trachea and had caused an esophago-tracheal fistula. The fistula itself could not be seen endoscopically, but was found by gastrographin swallow and CT-scan (Figure 1, Figure 2). According to CT-scan we estimated it to be located at about 2–3 cm distal from the beginning of the stenosis. The recurrent mediastinal tumor was estimated to have a length of 6 cm and infiltrated the gastric tube.


Laparotomy enables retrograde dilatation and stent placement for malignant esophago-respiratory fistula.

Rehders A, Cupisti K, Schmitt M, Renter MA, Kröpil P, Iskender O, Knoefel WT - World J Surg Oncol (2008)

Axial contrast enhanced CT image showed a mediastinal tumor with mediastinal air and a perforation of the tracheal wall (arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2267468&req=5

Figure 1: Axial contrast enhanced CT image showed a mediastinal tumor with mediastinal air and a perforation of the tracheal wall (arrow).
Mentions: A 66-year-old man presented with severe dysphagia, weight loss and recurrent pulmonary infections due to an esophago-tracheal fistula. Due to squamous cell carcinoma of the esophagus 17 month ago, he had undergone esophageal resection and interposition of a gastric tube with cervical anastomosis. This treatment was followed by adjuvant radio-chemotherapy (50 Gy with 5-FU and Cisplatin). The first signs of dysphagia developed 8 weeks before admission to our hospital. Initial endoscopic therapy revealed local tumor recurrence beginning at 21 cm from front incisors, but failed to provide palliation of dysphagia. The distal end of the stenosis could not be measured precisely due to high grade stenosis which could not be passed endoscopically. Though intravenous hyperalimentation was administered, the patient kept on losing weight. Furthermore recurrent pulmonary infections occurred and swallowing of salvia, without coughing became impossible. For palliative surgical treatment the patient was transferred to our institution. Unfortunately we found the esophageal lumen to be completely obstructed by recurrent tumor. Moreover the tumor had invaded the trachea and had caused an esophago-tracheal fistula. The fistula itself could not be seen endoscopically, but was found by gastrographin swallow and CT-scan (Figure 1, Figure 2). According to CT-scan we estimated it to be located at about 2–3 cm distal from the beginning of the stenosis. The recurrent mediastinal tumor was estimated to have a length of 6 cm and infiltrated the gastric tube.

Bottom Line: Using a guidewire the esophageal obstruction was traversed and dilated.Then it was possible to place an esophageal stent via an antegrade approach.Open surgery enables a safe access for retrograde endoscopic therapy in patients who had undergone esophageal resection with gastric interposition.

View Article: PubMed Central - HTML - PubMed

Affiliation: Klinik für Allgemein-, Viszeral- und Kinderchirurgie, Heinrich Heine Universität, Düsseldorf, Germany. rehders@med.uni-duesseldorf.de

ABSTRACT

Background: Malignant esophageal stenosis with complete obstruction and esophagorespiratory fistula (ERF) is difficult to treat with standard endoscopic techniques.

Case presentation: We report a patient in whom with local recurrence of esophageal carcinoma an esophagotracheal fistula occurred. Initially the patient had undergone esophageal resection with interposition of a gastric tube. Due to complete obstruction of the lumen by recurrent tumor conventional transoral stent placement failed. For retrograde dilatation a laparotomy was performed. Via a duodenal incision endoscopic access to the gastric tube was achieved. Using a guidewire the esophageal obstruction was traversed and dilated. Then it was possible to place an esophageal stent via an antegrade approach.

Conclusion: Open surgery enables a safe access for retrograde endoscopic therapy in patients who had undergone esophageal resection with gastric interposition.

Show MeSH
Related in: MedlinePlus