RESUMEN
Vascular rings are unusual congenital malformations. Among them, double aortic arch (DAA) is often difficult to diagnose due to its low incidence of symptoms. DAA can be associated with tracheal or esophageal compression and, in severe cases, could require tracheal intubation or chronic use of a nasogastric tube. This scenario favors the development of aortotracheal fistulas (ATF) or aortoe-sophageal fistulas (AEF). OBJECTIVE: To present a clinical case with an unusual association of DAA with ATF and to reinforce the importance of maintaining high diagnostic suspicion in patients with massive aerodigestive bleeding without an obvious source. CLINICAL CASE: A 32-week preterm newborn who required prolonged mechanical ventilation and presented intermittent episodes of massive oropharyngeal bleeding with hemodynamic compromise associated with lower airway obstruction without pulmonary hemorrhage. The patient underwent upper endoscopy and exploratory laparotomy without evidence of bleeding. Flexible nasopharyngolaryngoscopy and direct laryngoscopy also showed no abnormalities. A CT angiography showed complete DAA with indentation of the left dominant arch over the trachea, without severe stenosis or evidence of a fistula. AEF was suspected, so exploratory surgery was considered. However, the patient died before surgery due to a massive pulmonary hemorrhage. The autopsy revealed the presence of ATF. CONCLUSIONS: In patients with massive aerodigestive bleeding without an obvious source, the presence of DAA and possible AEF/ ATF should be considered. Imaging studies have a poor performance for this diagnosis, so surgery should be considered for diagnosis and treatment in these patients.
Asunto(s)
Fístula Esofágica , Anillo Vascular , Humanos , Recién Nacido , Anillo Vascular/complicaciones , Anillo Vascular/cirugía , Fístula Esofágica/diagnóstico , Fístula Esofágica/etiología , Fístula Esofágica/cirugía , Hemorragia Gastrointestinal/etiologíaRESUMEN
Atrio-esophageal fistula (AEF) is a rare (0.02-0.1%) complication of radiofrequency ablation for atrial fibrillation and is associated with high mortality. It typically presents between 2 and 6 weeks after catheter ablation. AEF was reported to be the second complication as cause of death after radiofrequency ablation with a mortality rate of 71%. Common clinical features of AEF include dysphagia, nausea, heartburn, hematemesis or melena, high fever, sepsis, pericardial or pleural effusions, mediastinitis, seizures, and stroke. Once the diagnosis of AEF is made, early surgical repair is mandatory. Herein, we report a case of a AEF treated surgically without extracorporeal circulation.
Asunto(s)
Fibrilación Atrial , Ablación por Catéter , Fístula Esofágica , Cardiopatías , Humanos , Fibrilación Atrial/complicaciones , Atrios Cardíacos/cirugía , Fístula Esofágica/etiología , Fístula Esofágica/cirugía , Fístula Esofágica/diagnóstico , Cardiopatías/etiología , Cardiopatías/cirugía , Cardiopatías/diagnóstico , Ablación por Catéter/efectos adversosRESUMEN
We discuss the case of an esophageal cancer patient treated by chemo and radiotherapy complicated by an esophageal stenosis and an iatrogenic broncho-esophageal fistula. This latter was managed with multiple palliative stenting procedures and colonic surgical bypass. Despite a long disease free survival but decreased quality of life and frailty, we came to the proposal of an extremely unusual form of treatment - physiological lung exclusion, with clinical benefit and so far without any drawbacks related to the procedure.
Asunto(s)
Fístula Bronquial , Fístula Esofágica , Neoplasias Esofágicas , Humanos , Fístula Esofágica/etiología , Fístula Esofágica/diagnóstico , Fístula Esofágica/terapia , Fístula Bronquial/etiología , Fístula Bronquial/diagnóstico , Neoplasias Esofágicas/cirugía , Neoplasias Esofágicas/terapia , Neoplasias Esofágicas/diagnóstico , Masculino , Stents , Estenosis Esofágica/etiología , Estenosis Esofágica/diagnóstico , Estenosis Esofágica/cirugía , Estenosis Esofágica/terapia , Anciano , Pulmón/diagnóstico por imagenRESUMEN
INTRODUCTION: Purulent pericarditis secondary to esophago-pericardial fistula is a serious complication that has been previously reported in patients with esophageal cancer treated with radio/chemotherapy and esophageal stenting. However, the presence of esophago-pericardial fistula as the first manifestation of advanced carcinoma of the esophagus is exceedingly infrequent. We report the case of a 61-year-old male who presented with sepsis, cardiac tamponade and septic shock who was found to have an esophago-pericardial fistula secondary to squamous carcinoma of the esophagus. Emergency pericardiocentesis was performed with subsequent hemodynamic improvement. The drained pericardial fluid was purulent in nature and cultures were positive for Streptococcus anginosus. A CT scan followed by upper gastrointestinal endoscopy with tissue biopsy confirmed the diagnosis of squamous cell carcinoma of the esophagus. A self-expanding covered stent was endoscopically placed to exclude the fistula and restore the esophageal lumen. In this report, we discuss some aspects related to the diagnosis and management of this serious clinical entity.
Asunto(s)
Carcinoma de Células Escamosas , Fístula Esofágica , Neoplasias Esofágicas , Pericarditis , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Esofágicas/patología , Neoplasias Esofágicas/complicaciones , Pericarditis/microbiología , Pericarditis/etiología , Pericarditis/terapia , Pericarditis/diagnóstico , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/complicaciones , Carcinoma de Células Escamosas/diagnóstico , Fístula Esofágica/etiología , Fístula Esofágica/diagnóstico , Infecciones Estreptocócicas/complicaciones , Infecciones Estreptocócicas/diagnóstico , Streptococcus anginosus/aislamiento & purificación , Pericardiocentesis , Stents , Tomografía Computarizada por Rayos X , Taponamiento Cardíaco/etiologíaAsunto(s)
Suministros de Energía Eléctrica , Fístula Esofágica , Cuerpos Extraños , Humanos , Fístula Esofágica/etiología , Fístula Esofágica/diagnóstico , Cuerpos Extraños/complicaciones , Masculino , Suministros de Energía Eléctrica/efectos adversos , Enfermedades de la Aorta/etiología , Enfermedades de la Aorta/diagnóstico , Lactante , Fístula Vascular/etiología , Fístula Vascular/diagnósticoRESUMEN
A correção endovascular da dissecção de aorta tipo B tem se mostrado como uma nova alternativa para reduzir o trauma cirúrgico. No entanto, as complicações de médio e longo prazo, tais como a fístula aortoesofágica, são ainda pouco conhecidas e pouco relatadas. O objetivo deste trabalho é descrever três casos de fístula aortoesofágica após o tratamento endovascular de 23 casos de dissecção de aorta descendente conduzidos pela equipe de Cirurgia Vascular da Santa Casa de São Paulo em um estudo retrospectivo. Esses pacientes apresentavam características em comum, como dissecção crônica, pós-operatório imediato sem intercorrências, necessidade de reintervenções, oclusão de troncos arteriais como a artéria subclávia, mesentérica, tronco celíaco, e, ainda, uma rápida evolução para o óbito após os primeiros sinais de fístula. Portanto, embora raramente descrita na literatura, a ocorrência de fístula aortoesofágica é uma complicação de causa até o momento indefinida do tratamento endovascular da dissecção de aorta descendente que merece atenção, dada sua recorrência e evolução fatal.
Endoluminal stent-graft for type B aortic dissection is a new alternative to reduce surgical trauma. However, medium- and long-term complications are still little known and poorly reported, such as the aortic-esophageal fistula. The objective of this study is to describe three cases of aortic-esophageal fistula after the endovascular treatment of 23 cases of descending aortic dissection conducted by the vascular surgery team of Santa Casa de São Paulo in a retrospective study. These patients presented some common characteristics: chronic dissection, successful early outcome, need of reinterventions, occlusion of arterial trunks such as subclavian artery, mesenteric artery, celiac trunk, and finally, a fast fatal course after the first fistula-related symptoms. Therefore, despite rarely described in the literature, aortic-esophageal fistula is a complication of the endovascular treatment of descending aortic dissection which demands attention due to its unpredictability, recurrence, and fatal outcome.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Aorta Torácica/patología , Esófago/patología , Fístula Esofágica/diagnóstico , Cuidados Posoperatorios/enfermería , Disección/métodos , Factores de Tiempo , Tomografía Computarizada de Emisión/métodosRESUMEN
Presentamos el caso de un varón de 70 años que sufrió una hemorragia digestiva alta exanguinante, con resultado final de muerte. Fue diagnosticada una fístula aorto-esofágica mediante escáner como causante de la misma, debida con alta probabilidad a una espina de pescado.
We report a case of a 70 old man, who suffered a severe upper gastrointestinal haemorrhage, with final result of death. A scanner diagnosed an aortoesophageal fistula, due with high probability to a fish thorn.
Asunto(s)
Humanos , Masculino , Anciano , Cuerpos Extraños/complicaciones , Fístula Esofágica/complicaciones , Fístula Esofágica/diagnóstico , Fístula Esofágica/etiología , Hemorragia Gastrointestinal/complicaciones , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiología , Enfermedades de la Aorta/diagnóstico , Enfermedades de la Aorta/etiología , Resultado Fatal , ChoqueRESUMEN
Reportamos el primer caso en nuestro medio de reconstrucción exitosa de un segmento esofágico, usando injerto libre de intestino. Se describe la técnica de dicho procedimiento. Esta operación es considerada como la de elección para ciertos defectos esofágicos considerando las ventajas funcionales sobre los colgajos cutáneos o miocutáneos tradicionales. Se resalta la importancia de la participación de un equipo conformado por cirujanos generales y cirujanos especialistas en microcirugía. Estas consideraciones limitan la aplicación de éste método de reconstrucción a centros que tengan la infraestructura para desarrollar procedimientos microquirúrgicos
Asunto(s)
Sistema Digestivo/cirugía , Enfermedades del Esófago/cirugía , Enfermedades del Esófago/mortalidad , Enfermedades del Esófago/patología , Intestino Delgado/cirugía , Intestino Delgado/trasplante , Perú , Microcirugia , Fístula Esofágica/cirugía , Fístula Esofágica/complicaciones , Fístula Esofágica/diagnósticoRESUMEN
Primary aorto-oesophageal fistula is a rare cause of massive and usually fatal gastrointestinal haemorrhage. We herein present a case of a 62-year-old chronic alcohol abuser who had a small haematemesis after a week of persistent vomiting. He succumbed to an exsanguinating bleed 36 hours after admission. An aorto-oesophageal fistula was found at autopsy. We emphasize the need for a high index of suspicion and recognition of premonitory signs for accurate diagnosis and management of this condition.
Asunto(s)
Enfermedades de la Aorta/complicaciones , Fístula Esofágica/complicaciones , Hemorragia Gastrointestinal/etiología , Aorta Torácica , Enfermedades de la Aorta/diagnóstico , Bario , Hematemesis/complicaciones , Fístula Esofágica/diagnóstico , Diagnóstico DiferencialRESUMEN
En este artículo se presentan los casos de dos pacientes con fístula del segundo arco branquial y, a partir de ahí, se hace una breve revisión de esta entidad. Se hace hincapié en la utilidad de la fistulografía para la planeación quirúrgica de esta entidad
Asunto(s)
Fístula Esofágica/diagnóstico , Fístula EsofágicaRESUMEN
La Fístula Aorto-esofágica es una condición poco frecuente pero altamente letal. Su diagnóstico precoz puede mejorar el pronóstico. El presente es un reporte de 3 casos de fístula aorto-esofágica por cuerpo extraño. Todos presentaron un caso clínico caracterizado por: historia de ingestión de cuerpo extraño, disfagia, dolor retroesternal y hematemesis. La endoscopia superior demostró lesión de la pared esofágica localizada entre 23-25 cm de la arcada dentaria en la zona comprendida por la pared esofágica lateral izquierda y la pared posterior. La ubicación de una lesión en esta localización debe sugerirnos el diagnóstico de fístula aorto-esofágica por cuerpo extraño en aquellos pacientes que presenten clínica similar a la antes descrita