Histologic evidence of tracheal stenosis directly resulting from SARS-CoV-2 tissue infiltration, a case series.

BACKGROUND: There has been an anecdotal increase in the incidence of tracheal stenosis that has coincided with the SARS-CoV-2 pandemic. CASE PRESENTATION: This is a case series in which we report clinical and pathologic findings of two patients who subsequently developed subglottic tracheal stenosis after having been hospitalized with COVID-19 pneumonia. Histopathologic analysis of tissue from these patients shows features consistent with tissue infiltrated with SARS-CoV-2 virus, namely multinucleated syncytial cells with prominent nucleoli. CONCLUSION: Our findings directly implicate SARS-CoV-2 in the pathogenesis of tracheal stenosis.

Esophageal Pulmonary-splenopancreatic Fistula: A Serious Complication of Sleeve Gastrectomy.

Esophagopulmonary fistulas are exceedingly rare and require surgical debridement and repair or diversion to prevent overwhelming sepsis. Fistulas that cross the diaphragm are even rarer. This report describes the case of a patient with an iatrogenic esophageal perforation after sleeve gastrectomy that was never managed definitively and in whom an esophagopulmonary-splenopancreatic fistula developed. The patient underwent an esophagectomy with esophagojejunostomy and distal pancreaticosplenectomy for management of the fistula. This case presents a rare complication of sleeve gastrectomy and highlights the need for early definitive management of esophageal perforations.

Enhanced Recovery After Thoracic Surgery (ERATS).

BACKGROUND: Decreasing the length of stay after thoracic surgery provides both clinical and financial benefits to both the patient and the clinical system. Since 2017, our institution has seen advancements in the care of patients undergoing thoracic surgery after utilising our protocol Enhanced Recovery After Thoracic Surgery (ERATS). METHODS: The protocol we implemented is comprehensive, including the patient's pain management, thoracostomy tube drainage, physical therapy and rehabilitation, ventilator support and pulmonary care, as well as other features of preoperative, intraoperative, and postoperative care. In a retrospective review, we compared the overall length of stay prior to the protocol implementation to the length of stay after initiating the changes. RESULTS: We identified a median decrease of 2 days (from 6 days to 4 days) following the implementation of this protocol for all types of thoracic surgical procedures (p<0.01). CONCLUSIONS: Upon implementation of the ERATS protocol, we appreciated a decrease in the length of stay of thoracic surgery patients at our institution.

A novel reconstruction technique of a tracheal defect in the emergent setting using a thymus flap in a patient with tracheoinnominate artery fistula.

BACKGROUND: There is a very high mortality associated with a tracheoinnominate artery fistula; however, when patients survive, they often require reconstruction of the eroded tracheal defect after the bleeding has been controlled. CASE PRESENTATION: This is the case of an 83-year-old male with a tracheoinnominate artery fistula who was stabilized in the operating room and underwent repair of his trachea. A novel technique of using the thymus gland as a pedicled flap to repair a large tracheal defect was executed after achieving hemostasis. The patient's defect was repaired successfully following control of the fistula. CONCLUSIONS: We have shown that the thymus gland can be used successfully as a pedicled flap for repair of a tracheal defect in the setting of a tracheoinnominate artery fistula.

Intersphincteric proctectomy for rectal mucocele in a Crohn's patient with anal stenosis. A case report and review of literature.

In patients who have undergone a colonic resection with creation of an end colostomy, drainage of mucus secreted by the mucosa of the rectal stump may not be possible if there is an outlet obstruction. With an outlet obstruction, formation of a rectal mucocele occurs. A rectal mucocele is a rare condition which has only been reported sporadically in case reports. We present here the utility of an intersphincteric proctectomy for treatment of a rectal mucocele in a 47 year old male Crohn's patient resulting in negligible post-operative or long-term morbidities.