ABSTRACT
Esophageal fistulas in the cervical region are usually difficult to manage and carry a high morbidity. We report a case of an esophago-colonic fistula after colonic interposition, successfully managed with vacuum-assisted closure 'V.A.C. system', (Kinetic Concepts Inc., San Antonio, TX, USA). The patient initially presented with purulent fluid from the cervical wound 13 days after surgery. Esophagogram confirmed a leak. Since the patient had a history of anastomotic leaks, a surgical intervention was not the treatment of choice. In light of this, conservative treatment with V.A.C. system was initiated. She underwent full recovery.
ABSTRACT
Mediastinitis secondary to esophageal perforation is usually a life-threatening problem associated with high morbidity and mortality. We present a 44-year-old morbidly obese female who underwent laparoscopic gastric bypass, during which she suffered perforation of the distal thoracic esophagus diagnosed 5 days later during progression of mediastinitis. She was treated with left posterolateral thoracotomy, drainage of a peri-esophageal abscess and primary repair of the esophagus with intercostal muscle reinforcement, and cervical esophagostomy. Thereafter, she had an uneventful hospital course, and remains well on 12-month follow-up.