Empyema due to spilled stones during laparoscopic cholecystectomy.
Kelty CJ. Thorpe JA.
Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield, UK.
We describe a patient who suffered right pleuritic chest pain and an exudative pleural effusion, leading to empyema formation. Thoracotomy revealed this to be due to a subphrenic abscess around spilled gall stones.
Dysphagia due to pancreatic pseudocyst with mediastinal extension.
Obuszko Z. Beggs D.
Department of Cardiothoracic Surgery, Nottingham City Hospital, Nottingham, UK.
This case report describes a patient who presented with severe dysphagia, found to be due to a large pancreatic pseudocyst extending into the mediastinum. The patient was successfully treated by cystgastrostomy.
Gastric bypass for malignant esophagotracheal fistula: a series of 21 cases.
Meunier B. Stasik C. Raoul JL. Spiliopoulos Y. Lakehal M. Campion JP. Launois B.
Department of Digestive Surgery, Service du B. Launois, Hopitaux Universitaires de Rennes, France.
OBJECTIVE: Patients with cancer of the esophagus who develop an esophagotracheal fistula die within 1 month in dramatic conditions of malnutrition and asphyxia. We assessed the beneficial palliative effect of the Kirschner operation in the treatment of esophagotracheal fistula. METHODS: Between January 1980 and August 1995, 21 patients among a continuous series of 847 with cancer of the esophagus developed an esophagotracheal fistula. Prior to surgery, 2 patients had an esophageal prosthesis followed by radio- and/or radiochemotherapy and 6 had radio- and/or chemotherapy at curative doses. The Kirschner operation was carried out in all patients with exclusion of the lower end of the esophagus using a Roux-en Y-loop (n = 19) or ligature (n = 2). RESULTS: Within 1 month of surgery, 8 patients (38%) died. Median length of stay in the intensive care unit and hospitalization was 6 days (1-30) and 17 days (3-57), respectively. Among the 13 survivors, pulmonary infections (n = 2) and cervical fistulae (n = 5) complicated the postoperative period. Among the cervical fistula, 3 of them resolved favorably. Radio- and/or chemotherapy was given postoperatively in 7 patients without any improvement in survival. Among the 13 patients surviving beyond the postoperative period, median survival was 109 days; 7 were able to resume oral nutrition and quality of life was assessed as excellent in 6 of them. CONCLUSION: The Kirschner operation can provide a beneficial palliative effect in patients with an esophagotracheal fistula despite the high risk of operative mortality. Ideally, the Kirschner should be carried out in young patients who are still in good general health, before the development of respiratory complications compromises surgery.
Protective subpleural blanketing of intrathoracic esogastric anastomosis after esophagectomy.
Spiliopoulos A. Robert JH. Murith N. Chassot G.
Clinic of cardiovascular and thoracic surgery, University Hospital, Geneva, Switzerland.
Esophagectomy followed by intrathoracic anastomosis is threatened by leakage which may prove all the more serious that mediastinal contamination is extensive. In the technique presented, the esogastric anastomosis is slipped under the upper mediastinal pleura which is kept intact, after the azygos vein has been ligated and divided. This pleural 'blanket' may act as an efficient barrier against potential digestive spillage into the mediastinum.