1/4. Use of a free jejunal graft for oesophageal reconstruction following perforation after cervical spine surgery: case report and review of the literature.STUDY DESIGN:: Single-subject (male, 16 years of age) case. OBJECTIVES: To demonstrate a suitable method for oesophageal repair after perforation as a complication of anterior spinal fusion in an individual with quadriplegia, and to review the literature on oesophageal perforation and repair. SETTING: University hospital, large trauma centre with departments for spinal injuries and reconstructive surgery in germany. methods: A free jejunal graft used for oesophageal reconstruction in a post-traumatic situation after a complicated treatment course in a C6 quadriplegic patient. RESULTS: A protuberant loose screw of the titanium plate after anterior spinal fusion perforated the oesophagus. Imbricating sutures and a fascia lata patch were insufficient to repair the oesophageal leakage. An 8 cm long segment of the cervical oesophagus including a fistula had to be excised, and a free microsurgical jejunal flap was used for restitution of continuity. The jejunal vessels were connected to the superior thyroid artery and external jugular vein. At 1 week after the oesophageal repair, an enteral contrast study showed a small amount of contrast medium leaking at the oesophago-pharyngeal anastomosis. A percutaneous gastric tube was inserted, and oral feeding was limited to tea and still water for 4 weeks. The further course was uneventful. CONCLUSIONS: Oesophageal perforation is a rare but recognized complication after cervical spine surgery, which can mostly be managed using secondary suture techniques. The free jejunal flap is a reliable and innovative tool in the particularly complex situation of a segmental oesophageal loss. It should be considered in similar cases to reconstruct oesophageal continuity or to treat stricture and fistula formations.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/4. Variceal recurrence after endoscopic sclerotherapy associated with the perforating veins in lower esophagus independently.BACKGROUND/AIMS: The perforating veins as a lateral blood supply route for esophageal varices in lower esophagus are associated with the recurrence of esophageal varices after sclerotherapy, but not vessels at the esophagogastric junction as an ascending blood supply route. To date, however, frequency of association perforating veins alone with variceal recurrence has not been investigated. To clarify the influence of perforating veins alone on variceal recurrence after endoscopic injection sclerotherapy, we studied the prevalence of variceal recurrence in patients with perforating veins detected by endoscopic ultrasonography after treatment. METHODOLOGY: Forty-two patients who underwent injection sclerotherapy and received endoscopic ultrasonography after treatment to evaluate the effect on the collaterals around the esophagus, were studied. Subjects were classified in four groups according to endosonographic findings as follows: group A: perforating veins ( ) and vessels at esophagogastric junction ( ), group B: perforating veins ( ) and vessels at esophagogastric junction (-), group C: perforating veins (-) and vessels at esophagogastric junction ( ), group D: perforating veins (-) and vessels at esophagogastric junction (-). RESULTS: Variceal recurrence was observed in 60% (6/10) of patients in group A, 64.3% (9/14) of patients in group B, 33.3% (1/3) of patients in group C, 0% (0/15) of patients in group D, respectively. The prevalence of variceal recurrence was compared between the 4 groups. No significant difference between group A or C and B was noted, and there was a significant difference between group A or B and D. CONCLUSIONS: These results suggested that perforating veins are highly associated with variceal recurrence after sclerotherapy even if perforating veins are independent.- - - - - - - - - - ranking = 5keywords = vessel (Clic here for more details about this article) |
3/4. Fatal massive hemorrhage caused by nasogastric tube misplacement in a patient with mediastinitis.Nasogastric tube insertion is a routine procedure in medical care. However, misplacement of the tube can cause a variety of complications, which can be life threatening in some instances. We report a case of fatal hemorrhagic shock immediately after nasogastric tube insertion in a patient undergoing debridement by video-assisted thoracoscopic surgery for mediastinitis. Emergency endoscopy showed that the bleeding came from the nasogastric tube which had perforated the esophagus and possibly tore an intrathoracic large vessel. The nasogastric tube insertion was considered to have directly produced the perforation because no esophageal perforation had been found on preoperative endoscopy. Factors contributing to the risk of esophageal perforation in this case included coexisting mediastinitis, surgical manipulation, endotracheal intubation, inability to cooperate during general anesthesia, and repetitive advancement of the nasogastric tube. Prompt clamping of the nasogastric tube or delayed insertion after failed attempts might have improved the outcome. This report illustrates the complication of massive bleeding that can occur immediately after misplaced insertion of a nasogastric tube. Extraordinary care should be taken to avoid misplacement of the nasogastric tube during insertion.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/4. Fatal upper esophageal hemorrhage caused by a previously ingested chicken bone: case report.Perforation of the upper esophageal wall by ingested bones can cause sudden death and death under suspicious circumstances. Perforation usually takes place at sites of physiologic and pathologic strictures. Temporary bleeding from the respiratory and digestive tracts is an important signal and may be crucial in the diagnosis of esophageal perforation and small vessel injury by ingested bone. Polymorphism and long symptomatology can cause diagnostic and therapeutic failure, thus presenting a special medicolegal problem. We present a case report of unknown cause of death and death under suspicious circumstances resulting from ingested bone perforation of upper esophagus. A chicken bone had been swallowed about 6 months before death caused by hemorrhage from a decubitus in the cervical esophagus. The patient underwent urgent surgery because of suspected bleeding of a ventricular ulcer.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |