Minimally Invasive Oesophagectomy: The Critical Care Perspective on a Complicated Case

Abstract

Purpose: Introduction: University Hospital Birmingham NHS Foundation Trust is a tertiary referral centre, with a collaboration of specialists involved in development of cutting edge surgical procedures. Minimally invasive surgery is the cutting edge of surgery yet its use remains limited with regards to oesophagectomy. There are a number of complications associated, most notably respiratory. Critical care plays a major role in the post operative care of these patients. The current first line imaging modality for pulmonary complications is x-ray. However the one dimensional x-ray image can be very difficult to interpret and very often has to be taken in conjunction with clinical findings. CT scanning however, gives a much more definitive diagnosis. Method: We retrospectively review the case of a 57 year old gentleman who underwent the newly developed minimally invasive procedure for oesophagectomy admitted to the Critical Care unit. Although there have been several reported cases of respiratory complications, there have been none presenting with an encysted hydro-pneumothorax resulting in failure of lung re-expansion post operatively, with impact on respiratory function and weaning as in this case. Results: Problems encountered included prolonged respiratory weaning and ITU stay. The cause of this was diagnosis of encysted hydro-pneumothorax. This was not detected with multiple chest radiographs or clinical findings until a CT scan was carried out. Discussion and Conclusions: We discuss the difficulties in detecting a diagnosis of encysted hydro-pneumothorax on one dimensional x-ray imaging and the role of CT scanning. This case highlights the difficulties with imaging interpretation, the role of CT scanning and the impact on treatment and ITU stay when dealing with this kind of diagnosis.