1/64. tracheoesophageal fistula caused by a self-expanding esophageal stent.A patient is presented who had previously undergone an esophagectomy for an adenocarcinoma of distal esophagus. He experienced repeated strictures at the esophagogastric anastomosis at 22 cm. After multiple dilatations, a self-expanding metal stent was placed. Four months later the upper edge of the stent eroded through the esophagus into the trachea, forming a tracheoesophageal fistula. Muscle flap repair was successful.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
2/64. A successful one-stage reconstruction of the esophagus in a newborn with a long gap esophageal atresia and tracheo-esophageal fistula.A method of one-stage surgery of long gap esophageal atresia was applied in a newborn child. An anterior muco-muscular flap was moulded from the upper pouch and transposed to the lower pouch of the esophagus. The technique allowed the tension in the anastomosis between the two parts of the esophagus to be reduced. The child had no feeding abnormalities during the follow-up till the age of 5 years.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
3/64. An unusual cause of tracheal stenosis.PURPOSE: To report a large chronic tracheal foreign body, causing tracheal stenosis in an 11-yr-old girl. CLINICAL FEATURES: The history was suggestive of obstructive airways disease with secondary bronchiectasis. Physical findings were crepitations and rhonchi all over the chest. blood gases were normal. Chest X-ray showed bronchiectasis and a ventilation perfusion scan identified a tracheo-esophageal fistula. During anesthesia to confirm this, intubation and ventilation were difficult because of tracheal stenosis. The hypoventilation resulted in severe hypercarbia and acidosis. A subsequent CT scan showed a stenosis of 2 mm diameter and 1 cm length in the middle third of trachea, bronchiectasis, and an air filled pocket between the trachea and esophagus. PFT showed a severe obstruction. Antitubercular treatment which was started on the presumptive diagnosis of tuberculous stenosis and tracheoesophageal fistula caused a delay with deterioration of patient from intermittent dyspnea to orthopnea with severe hypecarbia and acidosis. The anesthetic management of the tracheal reconstruction was difficult due to her moribund condition even after medical treatment, the short length of the trachea above the obstruction, its severity and lack of resources for alternative techniques. A large foreign body was found lying obliquely in the trachea dividing it into an anterior narrow airway mimicking a stenosed trachea, and a wider posterior blind passage. CONCLUSION: The anesthetic consequences were peculiar to the unexpected etiology of the stenosis and poor general condition of the patient. Minor details like the tracheal tube bevel and ventilatory pattern became vitally important.- - - - - - - - - - ranking = 1.1079903774566keywords = chest (Clic here for more details about this article) |
4/64. Patient tolerance of cervical esophageal metallic stents.PURPOSE: To demonstrate that proximal esophageal stenoses and tracheoesophageal fistulas can be adequately palliated with use of metallic stents without significant foreign-body sensation. MATERIALS AND methods: Between June 1994 and March 1999, 22 patients with lesions within 3 cm of the cricopharyngeus were treated by placement of metallic stents. The series was reviewed retrospectively. Twenty patients had surgically unresectable malignant lesions, two patients had benign disease. Ten patients had associated tracheoesophageal fistulas. In all, the upper limit of the stent was between C5 vertebral body inferior endplate and the T2 vertebral body superior endplate. The case-notes were reviewed until patient death (range, 6-198 days), or to date in the two surviving patients with benign disease. RESULTS: Immediate technical success was 93% (27 of 29). Dysphagia scores improved from a median of 3 to 2 after stent placement. Eighteen of 22 (82%) patients reported no foreign-body sensation. There have been no cases of proximal migration, periprocedural perforation, or deaths. The two patients with benign disease experienced significant complications. CONCLUSION: Lesions in proximity to the cricopharyngeus can be successfully palliated without significant foreign-body sensation in the majority of patients with use of metallic stents. The authors urge caution in placing stents in patients with benign disease.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
5/64. tracheoesophageal fistula after blunt chest trauma: successful diagnosis by computed tomography.A case of tracheoesophageal fistula after blunt trauma is reported. A 27-year-old man who suffered from an automobile traffic accident complained of strong choking after drinking water. Computed tomography demonstrated a defect between the esophagus and the trachea just above the carina. Acquired tracheoesophageal fistula was suspected and promptly confirmed by contrast esophagogram. The defects of the trachea and esophagus was repaired by primary suture and buttressed using a pedicled intercostal flap. The postoperative course was uneventful.- - - - - - - - - - ranking = 4.4319615098264keywords = chest (Clic here for more details about this article) |
6/64. Unilateral bronchiectasis and esophageal dysmotility in congenital adult tracheoesophageal fistula.Tracheoesophageal fistulas (TEF) in adults are most commonly neoplastic, and very rarely congenital in nature. We report a 45-year-old Hispanic male with TEF and initial presentation of minimal hemoptysis. The patient had radiographic evidence of unilateral upper lobe (RUL) bronchiectasis, massive esophageal dilatation, and dysmotility. However, there was no evidence of esophageal malignancy, achalasia, or Chagas' disease. bronchoscopy revealed a large TEF in the posterior wall of trachea, which was not visualized on esophagram or esophagoscopy. bronchoalveolar lavage (BAL) cultures grew mycobacterium avium complex (MAC). Our report illustrates that idiopathic, or congenital, TEF can be associated with esophageal dysmotility, adulthood bronchiectasis, and atypical mycobacterial superinfection.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
7/64. Congential H-type tracheo-oesophageal fistula.Five cases of congenital H-type tracheo-oesophageal fistula are presented. The clinical features common to all were choking and coughing precipitated by feeds, recurrent chest infections, and episodes of abdominal distension. The usefulness of repeated oesophagograms in diagnosing the condition is emphasized. Operation in all cases was by the cervical approach. The single postoperative death was related to pre-existent severe chest infection, and no postoperative complications were encountered in the other patients.- - - - - - - - - - ranking = 2.2159807549132keywords = chest (Clic here for more details about this article) |
8/64. Sudden intractable respiratory failure in extremely low birth weight infants with H-type tracheoesophageal fistula.A fatality from a tracheoesophageal fistula (TEF) in two extremely low birth weight infants is presented. The sudden onset of intractable respiratory failure accompanied by the absence of chest movement and breathing sounds was observed. The typical clinical symptoms were concealed because the infants required mechanical ventilation and nasogastric feedings. When ventilated infants with these symptoms are suspected of the diagnosis of TEF, prompt reintubation under the guidance of a flexible bronchoscopy may be life saving because the endotracheal tube passes through the fistulas into the esophagus with ease.- - - - - - - - - - ranking = 1.1079903774566keywords = chest (Clic here for more details about this article) |
9/64. VATER association.Baby S began oral feedings on day 8 at 20 ml/kg/day. The infant reached full enteral feedings on day 11 and was subsequently advanced to an ad lib demand schedule. The broviac catheter was removed on day 13. An orthopedic surgeon was consulted to evaluate abnormalities of the upper extremities and hip laxity noted on admission examination. The orthopedic specialist found decreased abduction of the hips bilaterally with no instability and normal range of motion on exam. An ultrasound showed bilateral posterior subluxation with no frank dislocation. The infant was evaluated by a physical therapist and received daily splinting and stretching of the upper extremities, with continued evaluation planned following discharge. When the infant was discharged on day 15, she was breastfeeding on a demand schedule with bottle supplementation and continued to receive ranitidine and metoclopramide. Follow-up was scheduled with the cardiologist, the orthopedic surgeon, and the family physician.- - - - - - - - - - ranking = 2keywords = upper (Clic here for more details about this article) |
10/64. Esophagotracheal fistula after lithium disc battery ingestion successfully treated with hyperbaric oxygen therapy.We report a case of a 12-month-old child who acquired an esophagotracheal fistula of 5 mm in diameter after an ingested lithium disc battery impaction. Failure to recognize foreign body on chest x-rays resulted in a delay of 28 days in establishing the diagnosis. Feeding via nasogastric tube and hyperbaric oxygen treatment (HBOT) resulted in a complete closure of the fistula after 17 HBOT 60 min sessions at 2.2 bars.- - - - - - - - - - ranking = 1.1079903774566keywords = chest (Clic here for more details about this article) |
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