Esophagocutaneous Fistula Research Articles

Transabdominal esophago-cutaneous fistula closure with endoscopic negative pressure therapy using a thin open-pore film drain in a pull-through technique.

Transabdominal esophago-cutaneous fistula closure with endoscopic negative pressure therapy using a thin open-pore film drain in a pull-through technique.

A Case Report of Non-surgical Esophagocutaneous Fistula Closure: Even a Blind Squirrel Finds a Nut

A Case Report of Non-surgical Esophagocutaneous Fistula Closure: Even a Blind Squirrel Finds a Nut

Pharyngoesophageal reconstruction with free jejunum or radial forearm flap as diversionary conduit: Functional outcomes of patients with persistent dysphagia and aspiration.

A diversion loop provides an alternative pathway for food intake from the bucco-gingival sulcus into the thoracic esophagus. Therefore, the bolus does not pass via pharynx where choking may occur in case of severe dysphagia. The data about outcomes and complications of the diversionary procedure are short and they refer to small cohort with brief follow-up. This retrospective study analyzed data of 48 patients, mean aged 34.3 years (range, 22-58 years), undergoing the creation of a diversion loop in two stages. Patients complained of aspiration, choking, and dysphagia. Swallowing disorders were caused by corrosive injury, radiation damage, or neurologic injury, and were investigated through laryngoscopy and esophagography. A diversion loop was created in 45 cases with free jejunal flap and in 3 cases with radial forearm flap. Complications, functional outcomes, and revision rate were reviewed. The mean follow-up was 26.3 months. We reported one failure (2%) and one partial necrosis of the free flaps. The most frequent complication was hematoma (8%). One case of esophagocutaneous fistula (2%) and two cases of stricture (4%) were also observed. Forty-two patients (87%) took all of the daily diet from their mouths through the diversionary conduit. A poor functional outcome was significantly associated with pre-operative radiotherapy (p < .0001). The diversion loop offers an alternative route for alimentation. Patients are freed from their choking obsession; moreover, they are rehabilitated into society without the drawbacks of permanent jejunostomy feeding. The technique was upgraded with caudal marginal mandibulectomy to improve the outcomes. Patients undergoing a diversionary procedure due to radiation damage should be carefully informed about the expected functional results.

Simultaneous Restoration of Swallowing and Voice Function With Ileocolon Free Flap.

Free ileocolon flap is a reliable technique allowing simultaneous restoration of swallowing and speech. The aim is to report our 6-year experience in a single center. Thirty-seven patients treated between 2010 and 2015 were included in the study. Swallowing and speech function were evaluated in 27 patients with a 7-point and 5-point Likert scale, respectively. Moreover, 12 of them consented to voice spectrum analysis (VSA). Complications noted were: aspiration (3), esophagocutaneous fistula (2), and stricture (1). Seven patients experienced self-limited diarrhea. Regarding swallowing function, 77.8% scored ≥5 on Likert scale whereas speech Likert scale showed excellent results (score >12) in 74%. VSA demonstrated mean phonation time of 10.75 seconds, mean frequency of 131 Hz and mean dynamic range of 56 dB. In experienced hands, the ileocolon flap is safe and effective, particularly in patients with long-life expectancy, providing good swallowing and speech function without further procedures/prostheses.

PS01.108: SPONTANEOUS ESOPHAGOCUTANEOUS FISTULA IN KIKUCHI DISEASE

Abstract Background Kikuchi disease is a rare, self-limiting condition that is characterized by histiocytic necrotizing lymphadenitis with unknown pathogenesis. Common presentation is cervical lymphadenopathy and fever in a previously well young female. Mediastinal lymph node involvement is uncommon. Methods We report a case of spontaneous esophagocutaneous fistula secondary to necrotizing mediastinal lymphadenopathy in a patient with Kikuchi disease. Results A 38-year-old lady presented with fever and right back pain of two weeks duration. She had background history of Kikuchi disease which was diagnosed 1 year ago. Examination revealed multiple enlarged left cervical lymph nodes and right back tenderness. CT scan showed an esophagocutaneous fistula with right paraspinal abscess and multiple enlarged cervical and mediastinal lymph nodes. OGDS revealed a 5mm fistula opening at right posterior wall of distal esophageal, 3cm proximal to esophagogastric junction. Rest of esophagus and stomach were normal. Tuberculosis and SLE workup were negative. Cervical lymph node biopsy was consistent with Kikuchi disease. She was treated as spontaneous esophagocutaneous fistula secondary to necrotizing mediastinal lymph node with underlying Kikuchi disease. Percutaneous drainage of paraspinal abscess was done and antibiotics were commenced. Laparoscopic feeding jejunostomy was done for feeding. Esophageal stenting and endoscopic clipping of fistula were attempted but the fistula tract persisted. She then underwent laparoscopic excision of esophageal fistula tract (LEEFT). Intraoperative findings were dense inflamed paraesophageal tissue with thickened fistula tract at right posterolateral wall of distal esophagus with multiple enlarged mediastinal lymph nodes. Fistula tract and the lymph nodes were excised via laparoscopic transhiatal approach. She had an uneventful recovery and was discharged on post-operative day 7. Conclusion Spontaneous esophageal fistula is rare and necrotizing mediastinal lymphadenopathy needs to be considered. Laparoscopic excision of esophageal fistula tract (LEEFT) is a novel transhiatal approach and it is feasible in distally located fistula. Disclosure All authors have declared no conflicts of interest.

VS02.03: LAPAROSCOPIC EXCISION OF ESOPHAGEAL FISTULA TRACT (LEEFT) IN A SPONTANEOUS ESOPHAGOCUTANEOUS FISTULA WITH KIKUCHI DISEASE

Abstract Description Spontaneous esophagocutaneous fistula is rare and necrotizing mediastinal lymphadenopathy is one of the causes. We report a case of spontaneous esophagocutaneous fistula in a 38-year-old lady with Kikuchi disease that was treated with laparoscopic excision of esophageal fistula tract (LEEFT). On endoscopy, the fistula opening was located at right posterolateral wall of distal esophagus, 3cm above esophagogastric junction. Esophageal stenting and endoscopic clipping of fistula were attempted but the fistula tract persisted. She then underwent laparoscopic excision of esophageal fistula tract. Laparoscopic excision of esophageal fistula tract (LEEFT) is a novel transhiatal technique as compared to the usual transthoracic aproach. Patient is placed in french position and it is done via 4-laparoscopic port technique with liver retraction. LEEFT is feasible in distally located esophageal fistula. In comparison to transthoracic aproach, the dissection and control of esophagus is easier with this technique as dissection through the chronic inflammatory tissue in the posterior mediastinum is avoided. Moreover, it spares the morbidity associated with single lung ventilation and transthoracic approach. Disclosure All authors have declared no conflicts of interest.

PS01.169: RADICAL ESOPHAGECTOMY COMBINED WITH RESECTION OF INVADED DESCENDING AORTA FOR T4 BARRETT’S ESOPHAGEAL CANCER

Abstract Background Esophageal cancer invading the descending aorta is a frequent subset of locally advanced unresectable esophageal cancer. Radical resection combined with removal of the descending aorta may be the only possible surgical approach for such tumors. Methods [Case report] A 58-year-old man who complained of dysphagia was referred to our hospital. Esophagogastroscopy showed the presence of long-segment Barrett's esophagus 19 cm from the incisors and a type 2 tumor 29–38cm from the incisors. Computed tomography revealed that the metastatic lymph node had markedly invaded the descending aorta and showed left adrenal gland metastasis. This patient was diagnosed with Stage IV lower thoracic Barrett's esophageal adenocarcinoma. The patient was treated with two courses of cisplatin plus 5-fluorouracil. After the chemotherapy, the main tumor, left adrenal gland metastasis and lymph node metastasis had not responded. We judged that R0 surgery was available for excision of the aorta because the distant metastasis was only left adrenal metastasis and there was no emergence of a new lesion. Results [Surgery] First we operated the neck and abdomen simultaneously in the supine position. Superior mediastinal dissection and esophageal transection were performed by mediastinoscope-assisted transhiatal esophagectomy technique. Removal of the left adrenal gland and abdominal esophageal transection were performed. The position of the patient was converted to the left lateral position. With left thoracotomy, the descending aorta was taped above and below the lesion. With ACT 200 or more by heparin administration, PCPC was provided. Transfer descending aorta was replaced with artificial blood vessel. After neutralization by protamine sulfate, the thoracic esophagus was safely removed. The artificial blood vessel was covered with omentum and indwelling thoracic drain was performed. Finally, an esophagocutaneous fistula was built in the anterior chest. The operation time was 14h38min, and the blood loss was 1730g with 2970ml blood transfusion. The patient stayed in the ICU for seven days and discharge was 22 days post-operative. Histopathological diagnosis is adenocarcinoma of Barrett's esophagus, 80 × 30mm, por&gt;tub2, pT4b (aorta). Conclusion Bilateral thoracotomy is necessary in radical surgery for aortic infiltrating thoracic esophageal cancer, but surgical stress is excessive. A mediastinoscope-assisted transhiatal esophagectomy approach is a minimally invasive option to avoid bilateral thoracotomy. Disclosure All authors have declared no conflicts of interest.

Abstract No. 441 VIABAHN stent-graft placement for emergent/urgent cervical cerebrovascular artery disease: a single-center experience of 22 cases

To report our single-center experience of Viabahn stent-graft placement for acute bleeding or pseudoaneurysms of innominate, cervical carotid, or vertebral artery in emergent/urgent clinical conditions. A retrospective study was conducted between Jan 2003 and Sep 2017. A total of 22 patients (14 male, 8 female; age range 18–82 years, mean 55.8 years and median 56 years) were treated with 22 Viabahn stent grafts (9 carotid blow-out syndrome and 13 pseudoaneurysms with or without dissection: 4 innominate, 4 common carotid, 12 internal carotid, 1 both common and internal carotid, and 1 vertebral artery involvement). The stent-graft patency was evaluated by angiogram, contrast-enhanced CT, MRA, ultrasonography, or direct observation during surgery. The mean and median imaging follow-up periods were 740 and 193 days, respectively. Technical success was 100% (22/22). Dual antiplatelet agents were given in 20 patients either immediately before or after the deployment of the stent-grafts. No immediate procedure-related complications occurred. Two unstable patients with carotid blow-out syndrome died of severe systemic disturbance within 8 days, despite successful bleeding cessation by the procedure. Three patients underwent subsequent bypass surgery within 17 days for concern about infection. One stent-graft occlusion occurred 195 days after the procedure with unexpected cession of antiplatelet therapy. One significant hemorrhagic complication was observed and died 125 days after the procedure (esophagocutaneous fistula). Two patients were lost to follow-up. Among the remaining 13 patients, 11 patients demonstrated 6 months or longer stent-graft patency and 2 developed more than 50% stenosis. Viabahn stent-grafting may be safe and useful for the management of emergent/urgent arterial bleeding or pseudoaneurysms involving cervical cerebrovascular arteries.

Controlled Esophagocutaneous Fistula with a T-Tube Drainage, as a Method of Control of Late Diagnosed Perforation of Acute Oesophageal Ulcer

Controlled Esophagocutaneous Fistula with a T-Tube Drainage, as a Method of Control of Late Diagnosed Perforation of Acute Oesophageal Ulcer

Free Jejunal Transfer for Reconstruction of an Esophago-cutaneous Fistula after Resection of Esophageal Cancer in a Patient with Right-sided Aortic Arch

Free Jejunal Transfer for Reconstruction of an Esophago-cutaneous Fistula after Resection of Esophageal Cancer in a Patient with Right-sided Aortic Arch

Surgical retrieval of a swallowed denture in a schizophrenic patient: a case report

BackgroundAccidental foreign body ingestion is a common phenomenon in children between 6 months to 6 years of age. In adults, foreign body ingestion is commonly observed in the geriatric population and in patients with psychiatric disorders. Over 80% of ingested foreign bodies pass uneventfully through the intestinal tract. Endoscopic retrieval is needed in about 20% while surgical intervention is indicated in less than 1%. Herein we report an extremely rare case of esophagocutaneous fistula following operative retrival of an impacted denture in the esophagus with spontaneous healing within 3 weeks. A similar case to the best of our knowledge has so far not been reported previously.Case presentationA case of accidental ingestion of a dental prosthesis in a 35-year old schizophrenic patient is presented. The patient was referred to our department after accidentally swallowing one of his dental prosthesis. Surgical retrieval was indicated after two unsuccessful endoscopic retrieval attempts. The denture was retrieved following a longitudinal incision of the esophagus via a left cervical approach. The postoperative course was complicated by a clinically suspected esophagocutaneous fistula which was managed conservatively via nothing per os with enteral feeding via a nasogastric tube. Secretion ceased 3 weeks later and a fistula could not be found on contrast enhanced radiographic examination with gastrographin®.ConclusionEsophagocutaneous fistula represents a rare but serious complication following foreign body ingestion. An interdisciplinary management including an early surgical consultation should be considered in patients with foreign body impaction in the esophagus following failure of endoscopic retrieval.

Tubercular esophagocutaneous fistula: Rare case report

Tubercular esophagocutaneous fistula is a rare entity with only about five cases reported so far. It can be as a result of primary involvement of esophagus by tuberculosis or due to spread of infection from adjacent structures like lungs or mediastinal lymph nodes. The fistula usually heals with initiation of antitubercular therapy and surgery is rarely required. Here we report a case of 65-year-old diabetic male who developed esophagocutaneous fistula secondary to caseation of mediastinal lymph nodes and was successfully treated with antitubercular treatment.

Non operative management of traumatic esophageal perforation leading to esophagocutaneous fistula in pediatric age group: review and case report.

Management of delayed presenting esophageal perforations has long been a topic of debate. Most authors consider definitive surgery being the management of choice. Management, however, differs in pediatric patients in consideration with better healing of younger tissues. We extensively review the role of aggressive non-operative management in pediatric esophageal perforations, especially with delayed presentation and exemplify with case of a young boy with esophageal perforation and esophago-cutaneous fistula. We also lay down the protocol to manage such patients based on our institutional recommendations.

Use of the microsurgical anterolateral thigh flap to correct esophagocutaneous fistula

Use of the microsurgical anterolateral thigh flap to correct esophagocutaneous fistula

Esophagocutaneous Fistula Following Thyroidectomy: An Uncommon Complication After a Common Procedure

Esophagocutaneous fistula is a very uncommon complication following thyroidectomy. We present a patient with this complication following thyroidectomy for differentiated thyroid cancer. A high index of suspicion is required from the surgeon to recognize this complication early. Diagnosis should be confirmed by esophagography and treatment is typically conservative. Meticulous surgical technique is required to avoid morbidity following thyroid surgery, including this uncommon and potentially severe complication.

Tubercular Esophagocutaneous Fistula in a child: Case report with review of literature

Tubercular esophagocutaneous fistula is a rare entity with only about five cases reported so far. To our best knowledge we herein report first case of tubercular esophagocutaneous fistula in neck of a child with a long tract which responded well to antitubercular treatment.

A “tuft” procedure

A 53-year-old man presented with dysphagia for solid food. He had a history of esophageal atresia that had required repair with a colonic interposition as a child. In 2008, he had presented with dysphagia, dyspnea, and a bulge in his neck. Computed tomography (CT) scanning showed herniation of the colonic conduit into his neck with ischemic changes. He had undergone emergency resection of the conduit and esophagogastric reconstruction, which was complicated by a tight anastomotic stricture that had been managed with esophageal dilation and stenting for 3 years. Unfortunately, a large anterior esophagocutaneous fistula had developed in his chest wall, which required repair in 2012 with a pectoralis major musculocutaneous skin flap to reconstruct his cervical esophagus. He was subsequently referred for endoscopy because of recurrence of his dysphagia.

Lateral Traumatic Esophago-Cutaneous fistula in a Child; Platelet-Rich Fibrin Glue Challenge

IntroductionThe endoscopic fibrin glue or platelet-rich fibrin glue (PRFG) injection is an easy, safe and effective technique for the fistula. So far, the use of fibrin glue has been limited to selected cases.Case reportOur case is a three years old male child with a neck trauma resulting in a Esophago-Cutaneous fistula after a 3 month period of follow up we decided to use PRFG for this lesion after fine debridement of the fistula tract, and the surrounding fibrosed tissue twice with a one week interval. Our visit after two weeks showed complete recovery and normal general condition. A contrast study revealed complete disappearance of the lesion.ConclusionsIn our case the PRFG completely resolved a long-standing fistula resistant to exhaustive conservative management. The treatment with PRFG has been proved to be effective in the selected cases and it seems that traumatic esophago-cutaneous fistula may be one of these selections. Application of fibrin sealant should be considered early in the management of these difficult clinical problems.

Esophageal tuberculosis presenting with hematemesis

Esophageal tuberculosis is rare, constituting about 0.3% of gastrointestinal tuberculosis. It presents commonly with dysphagia, cough, chest pain in addition to fever and weight loss. Complications may include hemorrhage from the lesion, development of arterioesophageal fistula, esophagocutaneous fistula or tracheoesophageal fistula. There are very few reports of esophageal tuberculosis presenting with hematemesis due to ulceration. We report a patient with hematemesis that was due to the erosion of tuberculous subcarinal lymph nodes into the esophagus. A 15-year-old boy presented with hemetemesis as his only complaint. Esophagogastroduodenoscopy (EGD) revealed an eccentric ulcerative lesion involving 50% of circumference of the esophagus. Biopsy showed caseating epitheloid granulomas with lymphocytic infiltrates suggestive of tuberculosis. Computerised tomography of the thorax revealed thickening of the mid-esophagus with enlarged mediastinal lymph nodes in the subcarinal region compressing the esophagus along with moderate right sided pleural effusion. Patient was treated with anti-tuberculosis therapy (Rifampicin, Isoniazid, Pyrazinamide, Ethambutol) for 6 mo. Repeat EGD showed scarring and mucosal tags with complete resolution of the esophageal ulcer.

A successful strategy for surgical treatment of Boerhaave’s syndrome

This retrospective single-institution study presents a successful treatment strategy for Boerhaave's syndrome. During 1995-2008, 15 patients with spontaneous esophageal perforation were treated. Patients were grouped according to time from symptoms to referral (early, <24 h; late, >24 h). In group I (early, n = 8 patients) treatment comprised primary surgical esophageal repair in seven cases and endoscopic clipping in one case. In group II (late, n = 7 patients) treatment comprised esophagectomy without primary reconstruction (4 cases) or controlled esophagocutaneous fistula (3 cases). Measures of outcome included age (years), delay to diagnosis (h), severe sepsis on admission, mortality, and hospital and intensive care unit (ICU) stay. The overall hospital mortality rate was 6.6% (1/15), being 0% (0/8) in group I and 14.2% (1/7) in group II. Patient age (49.6 vs. 68.6 years, P < 0.0001), delay to diagnosis (17.75 vs. 69 h, P < 0.0001), severe sepsis on admission (0 vs. 4, P = 0.0256), and ICU stay (4 vs. 14 days, P = 0.006) were all greater in group II. Early diagnosis and carefully selected therapeutic tactics can reduce the mortality rate of Boerhaave's syndrome to an acceptably low level. Methods of organ preservation and minimally invasive techniques can be applied successfully in the treatment.