Báo cáo khoa học: Laparotomy enables retrograde dilatation and stent placement for malignant esophago-respiratory fistula

Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành y học dành cho các bạn tham khảo đề tài: Laparotomy enables retrograde dilatation and stent placement for malignant esophago-respiratory fistula
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Báo cáo khoa học: "Laparotomy enables retrograde dilatation and stent placement for malignant esophago-respiratory fistula"World Journal of Surgical Oncology BioMed Central Open AccessCase reportLaparotomy enables retrograde dilatation and stent placement formalignant esophago-respiratory fistulaAlexander Rehders1, Kenko Cupisti*1, Marcus Schmitt2, Marc A Renter1,Patrick Kröpil3, Özcan Iskender1 and Wolfram T Knoefel1Address: 1Klinik für Allgemein-, Viszeral- und Kinderchirurgie, Heinrich Heine Universität, Düsseldorf, Germany, 2Klinik für Gastroenterologie,Hepatologie und Infektiologie, Heinrich Heine Universität, Düsseldorf, Germany and 3Institut für diagnostische Radiologie, Heinrich HeineUniversität, Düsseldorf, GermanyEmail: Alexander Rehders - rehders@med.uni-duesseldorf.de; Kenko Cupisti* - cupisti@uni-duesseldorf.de;Marcus Schmitt - marcus.schmitt@uni-duesseldorf.de; Marc A Renter - renter@uni-duesseldorf.de; Patrick Kröpil - kroepil@uni-duesseldorf.de;Özcan Iskender - iskender@uni-duesseldorf.de; Wolfram T Knoefel - knoefel@uni-duesseldorf.de* Corresponding authorPublished: 26 January 2008 Received: 9 July 2007 Accepted: 26 January 2008World Journal of Surgical Oncology 2008, 6:8 doi:10.1186/1477-7819-6-8This article is available from: http://www.wjso.com/content/6/1/8© 2008 Rehders et al; licensee BioMed Central Ltd.This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0),which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Background: Malignant esophageal stenosis with complete obstruction and esophagorespiratory fistula (ERF) is difficult to treat with standard endoscopic techniques. Case presentation: We report a patient in whom with local recurrence of esophageal carcinoma an esophagotracheal fistula occurred. Initially the patient had undergone esophageal resection with interposition of a gastric tube. Due to complete obstruction of the lumen by recurrent tumor conventional transoral stent placement failed. For retrograde dilatation a laparotomy was performed. Via a duodenal incision endoscopic access to the gastric tube was achieved. Using a guidewire the esophageal obstruction was traversed and dilated. Then it was possible to place an esophageal stent via an antegrade approach. Conclusion: Open surgery enables a safe access for retrograde endoscopic therapy in patients who had undergone esophageal resection with gastric interposition. ation has been reported in most patients[2,3]. The endo-BackgroundEsophageal cancer is an aggressive tumor with unfavora- scopic management of malignant obstruction and ERF isble prognosis. Despite the radical surgery, local recurrence technically challenging and requires careful endoscopicoccurs in up to 21% of the cases [1]. Dysphagias as well as dilatation with wire guided dilators. Despite of sophisti-esophago-respiratory fistulae (ERF) are predominant cated endoscopic strategies in some patients the passagesymptoms of local tumor recurrence and represent devas- of a guide wire is technically impossible due to a com-tating and life threatening complications. Patients are pletely obstructed lumen. In this situation retrogradeoften unable to swallow food or even their own saliva endoscopic dilatation via a radio guided percutaneouswithout aspiration. Unless sufficient palliation is insti- gastrostomy is a second option[4].tuted rapidly, the usual cause of death is pulmonary sepsisresulting from chronic aspiration. Since covered and self However in patients who underwent esophageal resectionexpandable stents have been introduced, successful palli- and transformation of the stomach into a small gastric Page 1 of 4 ...