Prolonged mechanical ventilation causing tracheoesophageal fistula

Tracheo esophageal fistula [TEF] is a congenital or acquired communication between the trachea and esophagus. These fistulae can often lead to fatal complications. Prolonged intubation with high compliance endotracheal tube cuffs used to prevent gas leak and also pulmonary aspiration may cause tracheal damageand lead to tracheoesophageal fistulae

We report a case of a young man developing a TEF after being intubated for multiple injuries with the intent to highlight this rare cause of severe complication and even death

Isolated corrosive pyloric stenosis without oesophageal involvement: An experience of 21 years

Corrosive ingestion is common in Asia and it is a frequent cause of morbidity secondary to intense fibrotic reaction and stricture formation of the oesophagus. Isolated corrosive pyloric stenosis without oesophageal involvement is an uncommon phenomenon. All consecutive patients, with corrosive ingestion in the last two decades, were reviewed and analysed. Eleven out of 201 patients with corrosive ingestion had isolated gastric outlet obstruction. Patients' age ranged from 11 to 29 years with a male: female ratio of 1.75:1. All patients developed pyloric stenosis following ingestion of solution of acids. Barium study revealed complete/ near-complete gastric outlet obstruction in all patients. On laparotomy, there was gastric dilatation in 10 patients, who underwent posterior gastrojejunostomy, whereas the stomach was contracted in one patient, and hence anterior gastrojejunostomy was performed. Seven patients were completely relieved of their symptoms; persistent postprandial epigastric fullness and/or dyspepsia was observed in four patients whose gastrojejunostomy stoma was found adequate on barium study, suggestive of gastric motility disorder. We did not encounter gastrojejunostomy-related complication of stomal ulcer/stenosis in our patients. Isolated corrosive pyloric stenosis is not as rare as is commonly thought. Gastrojejunostomy is effective, although a fair percentage of patients appear to develop gastric motility disorder secondary to corrosive injury

Role of proximal catheter ileostomy in typhoid enteric perforation

Addition of loop ileostomy with surgical repair of typhoid enteric perforation has recently reduced mortality rates but ileostomy itself is associated with high complication rates of 25-40%. This study was done to assess the effectiveness of proximal catheter ileostomy in these patients. Prospective study. J N Medical College Hospital, Aligarh Muslim University, Aligarh, India. Patients with typhoid enteric perforation who were treated surgically from November 2006 to November 2009. Proximal catheter ileostomy constructed along with primary surgical repair of typhoid enteric perforations when proximal defunctioning of bowel was considered advisable. Feasibility as well as outcome in terms of morbidity and mortality. Catheter ileostomy was performed in eight patients with typhoid enteric perforations treated by surgical repair. Patients' age ranged from 17 to 45 years [average 25.75 years] with a male to female ratio of 1:1. In the immediate postoperative period, two patients died of septicemia unrelated to catheter ileostomy. Catheter ileostomy started functioning within 48 hours of the operation and twice-daily irrigation was found sufficient. One patient developed mild peritubal leak that cleared within two days. Laparotomy wounds got infected in two patients. Ileostomy wounds closed spontaneously in all patients within 7-14 days after catheter removal. Mean hospital stay was 13.4 days. Follow-up was from 6- 36 months [average 24 months]. Catheler ileostomy is effective and safe in protecting primary repair of typhoid enteric perforations with minimal morbidity