Ten cases of gastro-tracheobronchial fistula: a serious complication after esophagectomy and reconstruction using posterior mediastinal gastric tube.

Gastro-tracheobronchial fistula (GTF) is a rare but life-threatening complication specifically observed after esophagectomy and reconstruction using posterior mediastinal gastric tube. Ten cases of GTF were encountered in three hospitals in 2000-2009. Their clinicopathological, surgical, and postoperative care are summarized, together with a review of previously reported cases. GTF was classified as anastomotic leakage (n= 5), gastric necrosis (n= 4), and gastric ulcer type (n= 1). The anastomotic leakage type appeared about 2 weeks (postoperative day [POD]: 8-35) after esophagectomy, was located in the cervical or higher thoracic trachea. Breathing and pneumonia were controlled by tracheal tube placed in the distal of fistula. The gastric necrosis type was noted in patients who developed necrosis of the upper part of the gastric tube and abscess formation behind the tracheal wall, at POD 20-36 around the carina, the site of pronounced ischemia. Due to the large fistula around the carina, emergency surgery with muscle patch repair was frequently required for the control of aspiration pneumonia. Patients of the gastric ulcer type had peptic ulcer in the lesser curvature of the gastric tube, which perforated into the right bronchus long after surgery (POD 630). With respect to tracheobronchial factors, preoperative chemoradiation (three cases) and pre-tracheal node dissection (three cases) tended to increase the risk of GTF. Closure of GTF by surgery (muscle patch repair) was successful in four cases and by nonsurgical treatment in three cases. In one case, stable oral intake was achieved by bypass operation without closure of GTF. Hospital death occurred in three cases. Understanding the pathogenesis and treatment options of GTF is important for surgeons who deal with esophageal cancer.

Communicating bronchopulmonary foregut malformations: classification and embryogenesis.

Communicating bronchopulmonary foregut malformations (CBPFMs) are characterized by a fistula between an isolated portion of respiratory tissue (ie, a lung, a lung lobe, or a segment) and esophagus or stomach. We combine our 30-year (1959 to 1989) experience of 6 cases with 51 reported patients to propose a CBPFM classification supported by a proposed embryogenesis theory. Group I (16%): anomaly is associated with esophageal atresia and tracheoesophageal fistula. Group II (33%): one lung originates from the lower esophagus. Group III (46%): an isolated anatomic lung lobe or segment communicates with the esophagus or stomach. Group IV (5%): A portion of the normal bronchial system communicates with the esophagus. The portion of the lung served by the communicating bronchus receives systemic blood supply. The right and left lung sacs curve dorsally to embrace the lower esophagus during normal lung development. At this stage a part of the lung bud joins the esophagus. This segment then breaks away from the main pulmonary anlage to form a CBPFM. CBPFMs should be considered in the workup of infants with respiratory distress and/or recurrent pneumonias. Patients with suspected pulmonary sequestration should undergo contrast studies to exclude a gastrointestinal communication.

Dehiscencia del muñón bronquial después de neumonectomías / Bronchial stump dehiscence after pneumonectomy

Entre los años 1983 y 1993 se trataron 14 pacientes con dehiscencias del muñón bronquial después de neumonectomías, divididos en dos grupos de acuerdo con el momento de aparición: dehiscencias tempranas (7 casos) y dehiscencias tardías (7 casos). Se describen posibles factores causales: técnicos en el primer grupo e infecciosos en el segundo. La conducta terapéutica, adaptada a cada caso en particular, estuvo orientada al manejo de la insuficiencia respiratoria, el control de la sepsis, el cierre del orificio fistuloso y la reparación de la cavidad residual. Se establecen normas orientadoras para el tratamiento (AU)

Dehiscencia del muñón bronquial después de neumonectomías / Bronchial stump dehiscence after pneumonectomy

Entre los años 1983 y 1993 se trataron 14 pacientes con dehiscencias del muñón bronquial después de neumonectomías, divididos en dos grupos de acuerdo con el momento de aparición: dehiscencias tempranas (7 casos) y dehiscencias tardías (7 casos). Se describen posibles factores causales: técnicos en el primer grupo e infecciosos en el segundo. La conducta terapéutica, adaptada a cada caso en particular, estuvo orientada al manejo de la insuficiencia respiratoria, el control de la sepsis, el cierre del orificio fistuloso y la reparación de la cavidad residual. Se establecen normas orientadoras para el tratamiento