Cervical Fistula Research Articles

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A Submandibular Sialolith of an Unusual Size Presenting With a Cervical Fistula Mimicking a Branchial Fistula: A Case Report

AbstractSialoliths greater than 10 mm in size can be called as those of an unusual size. Only 7.65 % of the sialoliths are >15 mm. Cutaneous fistulas due to submandibular sialoliths are even rarer. A case of a submandibular gland sialolith of an unusual size presenting with a cervical fistula mimicking a branchial fistula has been reported. Intra-operatively, the fistulous tract was found to extend upto the supraclavicular space. Complete excision of the gland along with fistulous tract was performed. Histopathology revealed a sialolith with acute and chronic sialedinitis. The lesion also mimicked a Kuttnor's tumour however a final diagnosis of the same could not be made due to inconclusive Ig G value and absence of plasmacytic infiltration.

An unusual iatrogenic cervical arteriovenous fistula: treatment of a rare vascular complication

An unusual iatrogenic cervical arteriovenous fistula: treatment of a rare vascular complication

感染を繰り返した乳児側頸瘻例

感染を繰り返した乳児側頸瘻例

Autografting mesenchymal stem cells with fibrin sealant for the therapy of esophageal anastomotic fistula

To investigate the efficacy of MSCs autografting with fibrin sealant could for the closure of cervical anastomotic fistula. Twenty-one healthy New Zealand rabbits were involved and randomly assigned to treatment group (n = 12) or control group (n = 9). After the bone marrow were aspirated, the MSCs were isolated, purified and labelled by transfection of Lenti. GFP. The rabbit models of cervical esophageal anastomotic fistula were established by leaving a caliber rubber tube inside esophageal lumen. One week later, a 0.2 ml FS with 2 x 10(6) GFP+ MSCs was employed to close the fistula for each animal in the treatment group, while the same procedure was performed without MSCs in the control group. MRI examination was performed to evaluate the closure of fistula after 5 weeks. All animals were killed and the esophageal tissues were collected 7 weeks later. Histology and immunohistochemistry study were performed. The rabbit models of cervical anastomotic fistula were successfully established. There was no significant difference of fisutla caliber between both groups ( (2.30 ± 0.15) mm vs (2.20 ± 0.17) mm, P < 0.05), MRI exam revealed that there was only inflammation sign in the treatment group, by contrast, most of the rabbits were showed purulent infection sign which induced by persistent fistula in the control group. At the end of the study, the mortality of the treatment group and the control group were 3/12 and 5/9 (P = 0.20). However, the closure rates of the fistula were 10/12 and 1/9, respectively, with significant difference between two groups (P = 0.02). Histological study indicated that there was mild inflammation response and less collagen deposition for treatment group, compared to control group. Immunohistochemistry study further demonstrated that the autografted MSCs colonized to the fistula and differentiated into myofibroblasts. Auto-transplantation of MSCs and FS can increase the closure rate of the cervical anastomotic fistula through the mechanisms of immunomodulatory, extracellular matrix reconstruction and anti-immigration effect of FS.

Lower Cervical Spinal Dural Arteriovenous Fistula with Extradural Hematoma in a 12-year-old Boy Presenting with Alternating Hemiplegia

경부 척수 경막 동정맥루(SDAVF)는 진행성 상위 운동 신경원성 증상을 초래하는 드문 혈관 기형으로, 샛길(fistula)은 경추부에서도 발생하지만 대부분은 흉추부와 요추부에 위치한다. SDAVF는 여성에 비해 남성에서의 발생빈도가 4­5배 높고, 중년의 나이에 호발하는 것으로 알려졌으나, 12세 남아에서 초기 증상으로 교대마비를 보이면서 급속히 진행하는...

RECONSTITUCIÓN DE TRÁNSITO ESOFÁGICO CON INTERPOSICIÓN DE COLON DERECHO

esophageal reconstruction using right colon interposition background: Esophageal replacement therapy is indicated for benign and malignant esophageal lesions and can be performed using stomach, jejunum or colon. aim: To report the experience using right colon interposition for esophageal replacement. material and methods: Review of medical records of 41 patients aged 17 to 73 years (29 males), subjected to right colon interposition in the last 20 years. Indications, complications, mortality and long term results were recorded. results: Forty nine percent of patients had a malignant esophageal lesion. Esophagectomy was performed using a transhiatal route or thoracotomy in 44 and 30% of patients, respectively. Retroesternal ascension was the most common route used in 88% of patients. The most common surgical complication was cervical fistula in 29% of patients, followed by fistula of the anastomosis between colon and jejunum in 7% of patients. Pneumonia was the most common medical complication. Postoperative mortality was 7%. conclusions: The mortality in this series of patients is similar to that reported elsewhere.

Initial results of robotic esophagectomy for esophageal cancer

IntroductionThere is scant experience with robot-assisted esophagectomy in cases of esophageal and gastro-esophageal junction cancer. Our aim is to report our current experience. Patients and methodsObservational cohort study of the first 32 patients who underwent minimally invasive esophagectomy for esophageal cancer from September 2011 to June 2014. The gastric tube was created laparoscopically. In the thoracic field, a robot-assisted thoracoscopic approach was performed in the prone position with intrathoracic robotic hand-sewn anastomosis. Patient and tumour characteristics, surgical technique, short-term outcomes (morbidity and mortality) and oncological results (radicality and number of removed nodes) were evaluated. ResultsThirty-two patients, with a mean age of 58 years (34–74), were treated by a totally minimally invasive esophagectomy: robotic laparoscopy and thoracoscopy (11 McKeown and 21 Ivor-Lewis). Twenty-nine received neoadjuvant chemoradiotherapy. There were no conversions to open surgery. Console time was 218min (190–285). Blood loss was 170ml (40–255). One patient died from cardiac disease. Nine patients had a major complication (Dindo-Clavien grade II or higher). There was no case of respiratory complication or recurrent laryngeal nerve palsy. Five patients had intrathoracic fistula, 4 radiological and one clinical. Three had chylothorax, 2 cervical fistula and one gastric tube necrosis. The median hospital stay was 12 days (8–50). All the resections were R0 and the median of removed lymph nodes was 16 (2–23). ConclusionsOur results suggest that minimally invasive esophagectomy with robot-assisted thoracoscopy is safe and achieves oncological standards.

Novel partial duplication of EYA1 causes branchiootic syndrome in a large Brazilian family

Objective: To identify novel genetic causes of syndromic hearing loss in Brazil. Design: To map a candidate chromosomal region through linkage studies in an extensive Brazilian family and identify novel pathogenic variants using sequencing and array-CGH. Study sample: Brazilian pedigree with individuals affected by BO syndrome characterized by deafness and malformations of outer, middle and inner ear, auricular and cervical fistulae, but no renal abnormalities. Results: Whole genome microarray-SNP scanning on samples of 11 affected individuals detected a multipoint Lod score of 2.6 in the EYA1 gene region (chromosome 8). Sequencing of EYA1 in affected patients did not reveal pathogenic mutations. However, oligonucleotide-array-CGH detected a duplication of 71.8Kb involving exons 4 to 10 of EYA1 (heterozygous state). Real-time-PCR confirmed the duplication in fourteen of fifteen affected individuals and absence in 13 unaffected individuals. The exception involved a consanguineous parentage and was assumed to involve a different genetic mechanism. Conclusions: Our findings implicate this EYA1 partial duplication segregating with BO phenotype in a Brazilian pedigree and is the first description of a large duplication leading to the BOR/BO syndrome.

Resultados iniciales de la esofaguectomía robótica en el cáncer de esófago

IntroductionThere is scant experience with robot-assisted esophagectomy in cases of esophageal and gastro-esophageal junction cancer. Our aim is to report our current experience. Patients and methodsObservational cohort study of the first 32 patients who underwent minimally invasive esophagectomy for esophageal cancer from September 2011 to June 2014. The gastric tube was created laparoscopically. In the thoracic field, a robot-assisted thoracoscopic approach was performed in the prone position with intrathoracic robotic hand-sewn anastomosis. Patient and tumour characteristics, surgical technique, short-term outcomes (morbidity and mortality) and oncological results (radicality and number of removed nodes) were evaluated. ResultsThirty-two patients, with a mean age of 58 years (34-74) were treated by a totally minimally invasive esophagectomy: robotic laparoscopy and thoracoscopy (11 McKeown and 21 Ivor-Lewis). Twenty-nine received neoadjuvant chemoradiotherapy. There were no conversions to open surgery. Console time was 218minutes (190-285). Blood loss was 170ml (40-255). One patient died from cardiac disease. Nine patients had a major complication (Dindo-Clavien grade II or higher). There was no case of respiratory complication or recurrent laryngeal nerve palsy. Five patients had intrathoracic fistula, 4 radiological and one clinical. Three had chylothorax, 2 cervical fistula and one gastric tube necrosis. The median hospital stay was 12 days (8-50). All the resections were R0 and the median of removed lymph nodes was 16 (2-23). ConclusionsOur results suggest that minimally invasive esophagectomy with robot-assisted thoracoscopy is safe and achieves oncological standards.

Successful Pregnancy Outcome after Laparoscopic Cerclage in a Patient with Cervicovaginal Fistula.

Obstetric fistula usually originates from obstructed labor or, less often, from invasive maneuvers on the genital tract or the pregnant uterus. Overall, it is a rare finding in the obstetric practice of high income countries. In this report we describe the case of a successful term pregnancy in a patient with a history of recurrent late miscarriage due to a large cervical fistula of traumatic origin, connecting the uterine cavity and the posterior vaginal fornix. A combined approach of laparoscopic cerclage and transvaginal fistula repair effectively restored cervical competence and created the conditions for a viable birth in a subsequent pregnancy. This unusual cause of cervical incompetence may be included in the indications which benefit from an abdominal cerclage carried out as a minimally invasive procedure in the nonpregnant state.

Colon interposition graft for corrosive esophageal stricture: midterm functional outcome.

Corrosive esophageal stricture is a major cause of morbidity among Nigerians. In most cases, this follows accidental or parasuicidal ingestion of caustic sodium hydroxide solution (NaOH) often used in the local production of soaps. Various treatment modalities have been advocated for the treatment of esophageal stricture. In this study, we review the results of our adopted technique in the past 10 years for pedicled colonic interposition. This is a retrospective study of 21 patients who underwent substernal isoperistaltic pedicled colonic interposition graft for management of corrosive esophageal stricture. The right colon was pulled up into the neck in all the patients without resecting the strictured esophagus. Long segment strictures and multiple strictures were the main indications for the procedure. The mean duration of the procedure was 339.6 ± 71.1 min. The average intraoperative blood loss was 673.1 ± 398.1 mL. There were two (9.5 %) hospital mortalities. Graft infarction (9.5 %), cervical fistulae (19.0 %), and reflux neo-esophagitis (14.3 %) were the main non-fatal complications. In the mid-term, dysphagia was completely relieved in a little over 84 % (16/19) of patients, while one patient (4.8 %) still experienced reflux neo-esophagitis requiring treatment. There was no case of gross regurgitation or nocturnal aspiration in the mid-term. Although the use of pedicled colonic interposition graft offers a good mid-term functional outcome with relief of dysphagia, early postoperative morbidity is high. Graft infarction is the single most important factor for poor functional outcome and every effort must be made to prevent its occurrence.

A rare case report of Congenital Glossocervical Fistula

The vast majority of all branchial disorders are thought to be associated with the second branchial cleft apparatus. Lateral cervical fistula results due to incomplete obliteration of second branchial cleft and pouch. Classically these fistulae have a well-defined pathway through the neck. Most common opening in the oropharynx is the tonsillar fossa. An incomplete branchial fistula is a common anomaly but complete branchial fistula is rare. Here we report a case of a left glossocervical fistula with external opening over anterior border of sternomastoid muscle passing deep to platysma with internal opening at lateral part of base tongue at the level of circumvallate papillae which is very rare.

A Case of Branchio-oto-renal Syndrome

Branchio-oto-renal (BOR) syndrome is an autosomal dominant disorder with branchial anomalies: ear malformation, hearing loss, cervical fistula, and renal anomalies. We experienced a case of BOR syndrome. A 16-year-old female had bilateral preauricular pits, bilateral hearing loss, left cervical fistula, and right renal aplasia. Computed tomography revealed inner ear anomalies with cochlear hypoplasia and an enlarged internal auditory meatus. We treated left cervical fistula only in this case. As the rate of improvement in hearing loss by surgical treatment such as tympanoplasty is not necessarily high, we should decide the indication for surgery carefully.

Management of a Dislodged Stent In Boerhaave Syndrome: A Case Report

Purpose: Boerhaave syndrome (BS) is a spontaneous perforation of the esophagus that can arise due to increased intraesophageal pressure combined with a negative intrathoracic pressure when vomiting against a closed glottis. Evidence of free perforation is serious and requires either surgery or endoscopic therapy with self-expandable metal stents (SEMS) or self-expandable plastic stents (SEPS). Esophageal perforation can be fatal in the absence of therapy. We present here a case of BS treated with a SEPS complicated by complete closure of the cervical esophagus necessitating percutaneous endoscopic intervention. A 41-year-old male with history of proximal and distal esophageal perforation 10 months prior to presentation following severe emesis was referred to cardiothoracic surgery for further management. He was treated with diversion of the cervical esophagus through the neck (cervical fistula) as well as stenting of the distal perforation with a SEPS at an outside facility. A G-tube was then placed for alimentation. Initial evaluation with x-ray found the stent was dislodged in the stomach. Barium esophagogram showed no leakage in the distal esophagus with a well-healed distal tear with leakage from the cervical fistula (CF). Narrowing of the lumen just distal to the CF measuring 4 mm was also observed. Gastroenterology was consulted to retrieve the displaced stent prior to the surgical repair of the cervical esophagus. Given the concern for perforation, an upper endoscopy was performed through the CF in the neck. With the help of the cardiothoracic surgeons, the CF opening was dilated and the scope was introduced until it reached the esophageal lumen. The dislodged stent was seen in the stomach. It was retrieved using rat tooth forceps, and after some manipulation the stent was extracted in one piece through the dilated neck fistula. Because the esophageal mucosa appeared irritated following these maneuvers the CF was taken down and the esophagus was successfully reconstructed one month later. Conclusion: To the best of our knowledge, this is the first case report of Boerhaave syndrome repair in which a cervical fistula created therapeutically was also utilized for both endoscopy and stent removal. This case illustrates that endoscopy can be used in an unconventional manner successfully when medically appropriate, although such a technique is not without its own risks.

Retrievable Stent Technique and Coil Embolization of High-Flow Iatrogenic Cervical Vertebral Arteriovenous Fistula

Cervical vertebral arteriovenous fistulas (VAFs) are rare clinical entities between the vertebral artery and veins of the neighborhood. We report the first approach in the literature experience in the treatment of high-flow VAF caused by percutaneous catheterization of the internal jugular vein, which was successfully occluded with coils and Solitaire AB neurovascular remodeling device system that can be fully retrieved even when fully deployed for procedural control. Complete angiographic and clinical cure was achieved, and no complications related to the new embolization procedure occurred.

Divertículo faringoesofagiano: avaliação dos resultados do tratamento

To evaluate the postoperative outcome of patients with pharyngoesophageal diverticulum submitted to surgical and endoscopic treatments. We retrospectively analyzed 36 patients with pharyngo-esophageal diverticulum treated at the Hospital of the Medical School of Botucatu - UNESP. Patients were divided into two groups, depending on the treatment: group 1 (n = 24): diverticulectomy associated myotomy through a left cervicotomy; group 2 (n = 12): endoscopic diverticulostomy with linear stapler. Operative mortality was zero in both groups. Early complications: group 1 - two patients developed cervical fistula and two, hoarseness; group 2 - none. Late complications: group 1 - none; group 2: recurrence of dysphagia in four patients (p = .01). Mean follow-up was 33 months for group 1 and 28 months for group 2. Both procedures were effective in remission of dysphagia. Surgical treatment showed superiority to endoscopy, with resolution of dysphagia with a single procedure. Endoscopic treatment should be reserved for the elderly and those with comorbidities.

Diverticulopexia no tratamento do divertículo de Zenker

Zenker's diverticulum is a pseudodiverticulum through a muscular defect in the posterior pharyngeal wall at the area between the inferior pharyngeal constrictor muscles of the pharynx and the cricopharyngeus muscle. Although endoscopic techniques have made significant progress, the surgical treatment remains the gold standard. There are two main techniques: diverticulectomy (resection of the diverticulum) and diverticulopexy. The main advantages of diverticulopexy are mostly linked to the absence of an esophageal anatomosis and its possible complications: cervical fistulae, mediastinitis, esophageal stenosis and wound infection, which allows a rapid recover with satisfactory oral intake. The purpose of this article is to describe in details the technique for diverticulopexy to the prevertebral ligament in association with a miotomy of the cricopharyngeus muscle.

Indications of Microsurgery in Soft Tissue Sarcomas

Sarcomas are uncommon tumors and free-margin surgical resection remains the single most important treatment in the curative therapy of soft tissue sarcomas. Refinements in surgical techniques have led to increased function preservation and limb salvage. The records of patients (n = 41) who underwent microsurgical soft tissue reconstruction subsequent to resection of soft tissue sarcoma during the period 1998 to 2010 were reviewed and compared with a general nonmicrosurgery group (n = 188) in relation to clinicopathological characteristics, surgical procedures, postoperative complications, time until start of adjuvant radiation, functional outcome (Toronto Extremity Salvage Score, TESS), local recurrence, free survival, and disease-specific survival. Forty-one patients (age range: 23 to 95 years) received a total of 42 free flaps. When compared with the general nonmicrosurgery group, these patients presented significant differences with regard to location, histological grade, and neoadjuvant treatments. Complications were encountered in 10 cases, including 3 patients with complete flap loss and 1 patient with partial flap loss; other complications were cervical fistulae, knee arthritis, nonconsolidation, and wound infection. Extremity salvage was achieved in 90% (19/21) of limb sarcomas, with these patients showing adequate postoperative ambulation (TESS 77 ± 16) and adequate use of the upper extremity (TESS 66 ± 26). Two patients underwent amputation after recurrence. Disease-specific survival rates at 5 and 10 years were 79.49% and 76.93%, respectively. The microsurgical repair of sarcoma defects is a reliable option that, though not free of complications, is necessary in selected cases such as patients receiving neoadjuvant treatments and those with head and neck location and high-grade tumors. The procedure enables both adequate oncosurgical resection and function preservation. Our microsurgical sarcoma reconstruction data, based on an observation period of 12 years and presenting the results of 42 free tissue transfers in 41 patients, adds further evidence to the previously published smaller series.

Left colonic graft in esophageal reconstruction for caustic stricture: mortality and morbidity

The adequacy of the blood supply to the left colon graft and its ability to transport food effectively from pharynx to stomach made it an esophageal substitute of choice, particularly in esophageal caustic stricture. From 1999 to 2009, 60 patients underwent colon interposition for esophageal caustic stricture (n= 57) and cancer (n= 3). An isoperistaltic colonic graft based on the left colonic artery could be used in all of these patients. The substernal route was used exclusively, and upper thoracic inlet was opened when necessary. The isoperistaltic left colonic graft interposed by substernal route represents the surgical procedure of choice in all operations performed for esophageal substitution during the study period. The operative mortality rate was 3.3%. A cervical fistula occurred in 10 patients (16.6%) and cervical anastomotic stricture in five patients (8.3%). Dilation was required in all the stricture of the esophageal colonic anastomosis with good response. The isoperistaltic left colic transplant supplied by the left colic pedicle is an excellent long-term replacement organ for the esophageal caustic stenosis. When performed by experienced surgeons, the left isoperistaltic esophagocoloplasty is a satisfactory surgical method for esophageal reconstruction with acceptable early morbidity and good long-term functional results.