Esophagopleural Fistula Research Articles

Esophago-Pleural Fistula Caused by Compression Necrosis In a Patient With Acute Type B Aortic Dissection.

Esophago-pleural fistula associated with thoracic aortic aneurysm is a rare and lethal complication. We report the case of a 62-year-old male who suffered from esophago-pleural fistula 56 days after thoracoabdominal aortic surgery. Contrasted CT showed that the fistula occurred at the level of the esophagus compressed by rapid dilatation of thoracic aorta and endoscopy revealed no ischemic signs on esophageal mucosa, demonstrating that the cause of esophago-pleural fistula was compression necrosis due to rapid dilatation of the thoracoabdominal aortic aneurysm.

Isolated secondary fungal infections of pleural cavity

Objectives: Pleural fungal infections are rare, but the incidence has been increasing with immunosuppressant diseases and use of immunosuppressive medications. In this report, we present 6 patients with pleural effusions that have been determined fungal infection. Methods: The medical records of patients with followed and treated due to fungal infection of the pleural were retrospectively reviewed. Result: The 6 cases whom was 58 of the value median for age were treated as surgical and medical due to fungal infection of the pleural cavity. Dyspnea, cough and chest pain were the most common symptoms. Fever, night sweats and expectoration are relatively rare. In 4 patients, the infections of pleural cavity developed on the bases of rheumatoid arthritis, tuberculosis, pleural mesothelioma and esophagopleural fistula. In two patients had isolated fungal infections. Cultural positivity was seen in 5 patients. Fungal hyphae were determined by cytopathology in all of the patients. As a surgical procedure, all of the patients underwent decortication or pleural biopsy and pleural irrigation. In all patients, antifungal agents were added to surgical procedures. Full recovery of infection was seen in 5 patients. One patient died. Conclusion: In immunosuppressive patients, the incidence of pleural effusions due to or associated with fungal infections are more common. Addition to culture of pleural fluid, histopathological evaluation of pleura will aid diagnosis. J Clin Exp Invest 2013; 4 (4): 443-446

Endoscopic Management of a Perforated Esophageal Adenocarcinoma

Purpose: Esophageal perforation secondary to dilation of esophageal malignancy can be a catastrophic event. Mediastinitis that results from the perforation can rapidly progress to purulent mediastinal collections and due to the close anatomic proximity between the esophagus and pleura, esophago-pleural fistula and empyema ensues. Surgical options are limited in this situation due to significant morbidity and mortality. We describe endoscopic management of such case with optimal clinical outcome. A 67-year-old gentleman presented to our ER with fever, right sided chest and back pain. An EGD was performed by a referring surgeon 3 days prior to presentation due to progressive solid food dysphagia and weight loss. A 5-cm malignant appearing mass was found in the mid to distal esophagus that was balloon dilated and biopsies confirmed a poorly differentiated adenocarcinoma. He felt back pain after the endoscopy however was reassured and sent home. Within 12 hours of the procedure he developed spiking fevers and pleuritic chest pain that radiated to his back. On admission BP was 80/60 mmHg and temperature, 39.3°C. CT scan revealed pneumomediastinum, an empyema in the right lung, and mediastinal fluid collection around aorta and heart with a free extravasation of contrast between esophagus and the fluid collection. An emergent EGD confirmed a 2.5-cm trans-mural perforation through the right esophageal wall with a clearly visible mediastinum. A partially covered wall flex metal stent was placed successfully across the defect. A subsequent CT scan confirmed completely sealed defect with no contrast extravasation. He underwent a trans-hiatal esophagectomy, pathology indicating a 5.5 cm invasive poorly differentiated T3 adenocarcinoma. His hospital course was finally complicated by development of a left pleural empyema which required decortication. After responding to antibiotics, he was discharged for palliative chemotherapy and radiation. Esophageal perforation requires emergent detection as it is crucial in a favorable clinical outcome. Empyema is diagnosed clinically with CT chest and pleural fluid studies which reveal leukocytosis, low pH (<7.20), low glucose (<60 mg/dL), a high LDH (lactate dehydrogenase), elevated protein and culture for pathogens. Definitive therapy entails emergent drainage and IV antibiotics. The prognosis of pleural empyema in the setting of malignancy is dependent on detection and expeditious closure of the anatomic defect.

Surgical outcome of esophageal tuberculosis secondary to mediastinal lymphadenitis in adults: experience from single center in China.

Esophageal tuberculosis (ET) is a rare disorder often easily misdiagnosed. The aim of this study is to evaluate the clinical features and to highlight the surgical role in treatment and complication management for undiagnosed ET. Between June 2006 and June 2011, six esophageal tuberculosis cases were retrospectively reviewed for their clinical presentations, radiological findings, endoscopic views, surgical treatment and outcome. The prevalent rate of ET was 0.30%. All patients, aged from 28 to 71 years, presented with dysphagia in six, weight loss in four, and each of retrosternal pain, epigastric pain, fever with cough in one. The duration ranged from two weeks to two months. Involvement of esophagus observed at middle segment in five patients, and at lower segment in one. Endoscopy demonstrated diverticulum with polyps in one patient, ulcer formation in one, and extraneous compression with intact mucosa in four. Five patients underwent video-assisted thoracoscopic surgery (VATS) and one was performed thoracotomy perforation repair for esophagopleural fistula. Diagnoses of all cases were confirmed by histopathological examination and acid-fast bacilli culture. Drug sensitivity test revealed multidrugs resistant mycobacterium tuberculous in one case. All patients discharged and recovered by antituberculous treatment with follow-up time ranged from 12 to 45 months. ET should be considered as a causative factor for dysphagia. Surgery should be applied in undiagnosed ET. VATS is useful in improving rate of confirmative diagnosis, and relieving symptom of dysphagia. Thoracotomy repair is reserved for complications of ET.

Closure of a persistent esophagopleural fistula using an over-the-scope clipping device

Closure of a persistent esophagopleural fistula using an over-the-scope clipping device

A New Surgical Technique for Spontaneous Esophagopleural Fistula after Pneumonectomy: Cervical Esophagogastrostomy via Presternal and Subcutaneous Route, Using a Thoracic Esophageal Mucosal Stripping

We report a new surgical technique for spontaneous esophagopleural fistula after pneumonectomy. A 67-year-old man underwent right pneumonectomy for tuberculosis-destroyed lung 30 years previously and a right Eloesser window for empyema without any evidence of fistula 4 years previously. He presented to our hospital for food material spillage out of the Eloesser window when he was eating. The esophagopleural fistula was observed from the upper thoracic esophagus to the right postpneumonectomy dead space. He underwent left cervical esophagogastrostomy via a presternal subcutaneous route, using thoracic esophageal mucosal stripping. He was discharged without complications on postoperative day 12.

A Case of Spontaneous Esophagopleural Fistula Successfully Treated by Endoscopic Stent Insertion

The most common cause of esophagorespiratory fistulas (ERFs) is associated with malignancy. The use of self-expandable metal stents is effective for the treatment of malignant ERFs, but benign ERF is rare, which is why its optimal treatment is not defined yet. There have been few reports describing benign esophagopleural fistula and its treatments in South Korea. Here, we report a rare case of spontaneous esophagopleural fistula, which was successfully treated by endoscopic placement of a membrane covered metal stent.

A case of juvenile dermatomyositis with esophago-pleural fistula caused by spontaneous lower esophageal perforation

Juvenile dermatomyositis (JDM) is a multisystem disease of uncertain origin that results in nonsuppurative inflammation of striated muscle and skin. Gastrointestinal perforation including esophagus is a well-recognized complication of JDM. A one year and nine months old girl with JDM was recently seen with esophago-pleural fistula. The fistula was caused by spontaneous lower esophageal perforation near the gastro-esophageal junction. The treatment consisted of adequate drainage of perforation site, total parenteral nutrition, long-term intravenous hydrocortisone, and broad-spectrum antibiotics. Although the duration of the fistula closing was long, the fistula spontaneously obliterated without other surgical management. This is a rare case of JDM with esophago-pleural fistula caused by spontaneous lower esophageal perforation.

A Pleural Effusion of Multiple Causes

Multiple medical disorders can lead to the development of pleural effusions. Most effusions are given a single diagnosis in clinical practice. However, the cause of the effusion can change during the disease course, and concomitant yet distinct causes are often underrecognized. We highlight this point by reporting a complex case of recurrent pleural effusions with different predominant causes during the disease course. Five causes for the pleural effusion were diagnosed, namely malignant pleural effusion, empyema, chylothorax, transudative pleural effusion secondary to hypoalbuminemia, and esophagopleural fistula. This case serves as a reminder to clinicians that recurrent pleural effusion, even within the same pleural space, can arise from different causes and, whenever clinically appropriate, reinvestigation of the pleural effusion may be needed.

Closure of a persistent esophagopleural fistula assisted by a novel endoscopic suturing system

Gastrointestinal fistulas may be successfully managed endoscopically [1]. Novel endoscopic techniques for full thickness tissue approximation may serve as adjuvants for assisting fistula closure [2] [3]; an example is a flexible endoscopic suturing system [4]. We describe a case of a chronic esophageal fistula, treated previously with endoscopic clipping and esophageal stenting, which was successfully managed using a novel endoscopic suturing system [5].

Complete obstructive esophageal cancer with esophagopleural fistula successfully treated by combined antegrade and retrograde rendezvous technique

Complete obstructive esophageal cancer with esophagopleural fistula successfully treated by combined antegrade and retrograde rendezvous technique

Complicaciones quirúrgicas de la resección pulmonar

We review incidence, etiology, diagnosis, prevention and treatment of the following complications of pulmonary resection: prolonged air leak, subcutaneous emphysema, residual pleural spaces, early bronchial stump dehiscence, bleeding, pleural empyema, bronchopleural fistula, esophagopleural fistula, chylothorax, cardiac herniation, pulmonary torsion, postpneumonectomy syndrome, nerve injuries and tumor embolism.

Esophagopleural Fistula In A 3 Year Old Child Following Disk Battery Ingestion.

Esophagopleural Fistula In A 3 Year Old Child Following Disk Battery Ingestion.

Embolization of Postsurgical Esophagopleural Fistula with AMPLATZER Vascular Plug, Coils, and Histoacryl Glue

Esophagopleural fistulas after esophageal diverticulectomy are very rare complications. Many treatment options have been reported, and the appropriate method should be chosen according to the individual's clinical status. The authors introduce a new treatment method of esophagopleural fistulas using an AMPLATZER vascular plug (AGA Medical Corporation, Plymouth, Minnesota), coils, and Histoacryl glue (B. Braun, Melsungen AG, Germany), thus avoiding extensive surgery or covered stent insertion.

Single Procedure Esophageal Bypass: A Valid Option In Delayed Surgical Intervention For Complicated Esophageal Perforation

We present a case report of Boerhaave syndrome or spontaneous post-emetic rupture of the esophagus complicated with an esophagopleural fistula of which the diagnosis was missed at the initial presentation in the emergency. Surgical intervention was delayed for more than two weeks until the esophageal perforation was recognized. The patient was optimized for surgery and a single-stage esophageal bypass surgery was done where the esophagus was left in situ, the stomach was pulled up through the substernal route and a cervical esophagogastric anastomosis was made to restore the gastrointestinal continuity; thus avoiding the morbidity associated with an esophagostomy and a second procedure for delayed reconstruction.

A case of juvenile dermatomyositis with esophago-pleural fistula caused by spontaneous lower esophageal perforation

Juvenile dermatomyositis (JDM) is a chronic multisystem disease characterized by nonsuppurative inflammation of striated muscle and skin. Gastrointestinal perforation including esophagus is a well-recognized complication of JDM. Corticosteroid therapy in JMD may be the cause of the ulceration and perforation of the gastrointestinal tract regardless of the diseasecourse. We describe a rare case of a one year and nine months old girl with juvenile dermatomyositis (JDM) who developed spontaneous lower esophageal perforation with esophago-pleural fistula. Although the duration of the fistula closing was long, the fistula spontaneously obliterated without other surgical management. This is a rare case of JDM with esophago-pleural，fistula caused by spontaneous lower esophageal perforation

Candida esophageal perforation and esophagopleural fistula: a case report

IntroductionEsophageal perforation is a rare disease, which can lead to significant morbidity and mortality. Its clinical presentation can mimic other disease processes and, therefore, it can be easily misdiagnosed. Candida infection of the esophagus is an extremely rare cause of esophageal perforation.Case presentationWe report the youngest pediatric case in the medical literature of spontaneous esophageal perforation and an esophagopleural fistula due to Candida infection.ConclusionA high index of suspicion, especially in the presence of Candida empyema and the absence of disseminated infection, should raise the possibility of esophageal perforation with esophagopleural fistula formation. This can lead to early diagnosis and surgical intervention, which would decrease the high mortality rate of this rare condition.

The use of self-expandable plastic stents for non-malignant esophago-pleural fistulas

Anastomotic leaks and fistulas are unfortunate complications of esophageal-gastric surgery and esophageal dilations. Traditional management options have included surgery or a more conservative approach. There have been few reports describing the use of self-expandable plastic stents for the treatment of esophageal perforations and tracheoesophageal fistulas from benign diseases. We are reporting the use of self-expandable plastic stents for the treatment of non-malignant esophago-pleural fistulas occurring after esophagectomy in one case and esophageal perforation post dilation in the other.

Successful tubes treatment of esophageal fistula

To discuss the merits of "tubes treatment" for esophageal fistula (EF). A 66-year-old female who suffered from a bronchoesophageal and esophagothoratic fistula underwent a successful "three tubes treatment" (close chest drainage, negative pressure suction at the leak, and nasojejunal feeding tube), combination of antibiotics, antacid drugs and nutritional support. Another 55-year-old male patient developed an esophagopleural fistula (EPF) after esophageal carcinoma operation. He too was treated conservatively with the three tubes strategy as mentioned above towards a favorable outcome. The two patients recovered with the tubes treatment, felt well and became able to eat and drink, presenting no complaint. Tubes treatment is an effective basic way for EF. It may be an alternative treatment option.

Barrett Esophagus and Unexpected Death

Barrett esophagus is characterized by the presence of columnar mucosa in the lower esophagus in continuity with gastric mucosa. Complications include ulceration and adenocarcinoma. Although sudden and unexpected death is not a usual outcome, the case of a 63-year-old man is presented who died unexpectedly following perforation of an ulcerated Barrett esophagus, with development of an esophagopleural fistula. Sudden and/or unexpected death in individuals with Barrett esophagus may result from hemorrhage due to erosion into mural vessels, the aorta or heart, or from penetration into the pleural space, trachea, bronchi, and pericardial sac, with the development of tension pyopneumothorax, bronchial fistula, and mediastinitis. Ulceration of the lower esophagus at autopsy should prompt consideration of the possibility of a Barrett esophagus and initiate careful dissection/examination of the surrounding mediastinal tissues and vessels.