Surgical approach for iatrogenic tracheoesophageal fistula. Case report and literature review.

BACKGROUND: Post-intubation tracheoesophageal fistula is a severe complication in long-term mechanical ventilation patients with possible fatal consequences. OBJECTIVE: To describe a case of post-intubation tracheoesophageal fistula and its surgical management. In addition, a brief literature review was effectuated. CASE REPORT: 45-year-old female, suffers ischemic stroke with progressive neurological damage that requires long-term mechanical ventilation. During endoscopic gastrostomy tracheoesophageal fistula is shown. RESULTS: Undergoes surgery for esophageal repair and tracheal resection, through cervicosternotomy. Unfortunately died in the immediate postoperative period. CONCLUSIONS: This complex pathology requires structured protocols for its prevention in patients in whom long-term mechanical ventilation is expected.

ANTECEDENTES: La fístula traqueoesofágica es una complicación en pacientes con ventilación mecánica prolongada. La contaminación pulmonar permanente puede ser grave, con evolución fatal. OBJETIVO: Describir un caso de fístula traqueoesofágica posintubación y hacer una breve revisión de la literatura. CASO CLÍNICO: Mujer de 45 años que sufre un evento cerebrovascular isquémico que condiciona deterioro neurológico progresivo, ameritando ventilación mecánica prolongada. Durante la gastrostomía endoscópica se evidencia una fístula. RESULTADOS: Intervenida quirúrgicamente para reparación esofágica y resección traqueal mediante cervicoesternotomía, lamentablemente fallece en el posoperatorio inmediato. CONCLUSIONES: Esta patología es compleja. Deben implementarse protocolos enfocados en su prevención en pacientes en quienes se espera una ventilación mecánica prolongada.

Moynihan's Lump as an unusual variant of right hepatic artery during a laparoscopic cholecystectomy approach. A case report.

INTRODUCTION AND IMPORTANCE: One of the most important measures during the cholecystectomy procedure is based on a "Culture for Safe Cholecystectomy (CSC)". Vascular injury reports an open surgery conversion rate of 0 to 1.9% and a mortality of less than 0.02%. The caterpillar or Moynihan's hump configuration is characterized by a tortuous right hepatic artery (RHA) running proximal and/or parallel to the cystic duct and predisposes to a small and/or short cystic artery (CA). CASE PRESENTATION: A 65-year-old woman with no relevant clinical history underwent a laparoscopic cholecystectomy (LC) for cholelithiasis; during the procedure a caterpillar or Moynihan's hump was identified. CLINICAL DISCUSSION: Anatomical variations represent 20-50% of all cases; therefore, CVS is required. The incidence of caterpillar or Moynihan's hump varies between 1% and 13% of all cases. To date, the scientific literature on this topic is limited. The most accepted etiology is related to embryological formation. CONCLUSION: Biliary and arterial variations are more frequent than we think, so an anatomical knowledge, CSC and CVS represent a fundamental rule, increasing the safety of the surgical procedure.