Case Of Bronchoesophageal Fistula Research Articles

Thoracoscopic approach as surgical management of esophageal epiphrenic diverticulum.

Management of diverticulum of the lower esophagus or epiphrenic diverticulum can be performed using the abdominal or thoracic approach. In some cases, the thoracic approach is preferred, but few studies have described thoracoscopic resection. The objective of the present study was to investigate the thoracoscopic approach for management of epiphrenic esophageal diverticulum. From 2008 to 2018, all patients undergoing surgery for epiphrenic esophageal diverticulum by the thoracoscopic approach were included in this single-center, retrospective, observational study. Data on diverticulum, surgery and follow-up were assessed. During the study period, 14 patients underwent surgery. Two patients had two diverticula. The mean location of the superior edge of the diverticulum was 7cm (2-14cm) above the gastro-esophageal junction. The mean size of the diverticulum was 39 millimeters (20-60). Thoracoscopic approach was used in all patients. No conversion to thoracotomy was required. Mean operative time was 168min (120-240). No postoperative mortality occurred. The overall complication rate was 40% (6 complications out of 15 resections), with three major complications including leaks (n=2) and a case of bronchoesophageal fistula (n=1). Median length of hospital stay was 12 days (8-40). At a mean postoperative follow-up of 20.7 months (5-71), 85% of patients had complete disappearance of preoperative symptoms without recurrence of the diverticulum on the barium swallow study test. Thoracoscopic approach as management of epiphrenic diverticulum is feasible, with acceptable short-term morbidity. The thoracoscopic approach is also effective in resolving preoperative symptoms.

S2088 A Case of Bronchoesophageal Fistula in an Older Patient Secondary to Malignancy

S2088 A Case of Bronchoesophageal Fistula in an Older Patient Secondary to Malignancy

内視鏡的に確認しえた, 肺癌治療後に生じた気管支 : 食道瘻の 1 例

内視鏡的に確認しえた, 肺癌治療後に生じた気管支 : 食道瘻の 1 例

Complications of Small Cell Lung Cancer Involving the Carina and Treatment with a Y-Stent

CHUM Endoscopic Tracheobronchial and Oesophageal Centre, Division of Thoracic Surgery, University of Montreal, Montreal, Quebec Correspondence: Dr Moishe Liberman, Department of Surgery, Division of Thoracic Surgery, Centre Hospitalier de l’Universite de Montreal, 1560 Sherbrooke Street East, 8th CD, Pavillon Lachapelle, Suite D-8051, Montreal, Quebec H2L 4M1. Telephone 514-890-8000 ext 26252, fax 514-412-7855, e-mail moishe.liberman@umontreal.ca The ‘Images in Respiratory Medicine’ section of the Canadian Respiratory Journal aims to highlight the importance of visual interpretation, whether physiological, radiological, bronchoscopic, surgical/thorascopic or histological, in the diagnosis of chest diseases. Submissions should exemplify a classic, particularly dramatic or intriguing presentation of a disease while offering an important educational message to the reader (insightful diagnostic pearls or differential diagnosis, etc). This section is not intended to be a vehicle for publication of case reports (see the Clinical-Pathologic-Conferences for case-based leaning series). Small cell lung cancer (SCLC) is a neuroendocrine tumour that is strongly linked with cigarette smoking and accounts for 15% to 25% of lung cancers. SCLC is discerned from non-SCLC by its rapid tumour doubling time and early dissemination. Patients with SCLC may present with varying signs and symptoms such as bloody sputum, chest pain, loss of appetite, shortness of breath, wheezing and weight loss. In the present article, we depict three different carinal complications of SCLC in three different patients. The bronchoscopy performed on the first patient shows an extrinsic compression of the right main bronchi at the carina level. In the second patient, the image demonstrates an invasion of the carina coupled with destruction of the cartilage of the right main bronchi. Finally, in the third patient, the bronchoscopy images reveal a case of bronchoesophageal fistula at the level of the carina and right main bronchus (Figures 1 to 4). A Y-stent was inserted under direct vision in all three patients to palliate their symptoms.

A Case of Broncho-esophageal fistula associated with Bronchiectasis

Broncho-esophageal fistula(BEF) is an uncommon clinical entity which can cause severe suppurative lung disease. Acquired fistulas between the esophagus and tracheobronchial tree are relatively uncommon. They are caused by many diseases including malignancy and chronic inflammation such as tuberculosis and have favorable outcome with proper treatment To our knowledge, there has been no description of patients with BEF due to the bronchiectasis. We report a case of broncho-esophageal fistula in association with bronchiectasis in a 35-year-old male patient with hemoptysis. Bronchoscopy revealed mild bleeding from the superior segment of the right lower lobe without specific endobronchial lesion. Barium esophagogram could not confirm the fistula. The diagnosis of a broncho-esophageal fistula was established by an esophagogastroscopy using fistulogram and subsequent bronchoscopy, in which the communication between the bronchial tree and the esophagus was demonstrated by instilling dye selectively through the fistulous opening using esophagogastroscopy and visualizing the fistula and the bronchial tree. The patient was treated with resection of the right lower lobe, extirpation of the diverticulum and surgical closure of the bronchial defect and fistula, but he suffered from pneumonia thereafter and eventually expired due to sepsis and multiple organ failure.