title: Tracheal compression by the stomach following gastric pull-up: diagnosis with CT and treatment with expandable metallic stent placement.
abstract: Surgical treatment of recurrent achalasia includes esophagectomy with gastric pull-up. A MEDLINE search yielded no articles describing an adverse effect of this surgery on pulmonary function. We report the first case of acute ventilatory failure caused by gastric pull-up. An evaluation by flexible bronchoscopy, spirometry with flow-volume loops, and dynamic CT scanning revealed extrinsic compression of the trachea by the stomach causing obstruction. Endotracheal placement of a self- expanding stent resulted in the rapid extubation of the patient with normalization of the flow-volume loop and dramatic improvement in the FVC, FEV(1), and peak expiratory flow.
authors.affiliation: Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, CA 94143-0359, USA.
authors.forename: Suil
authors.initials: S
authors.lastname: Kim
authors.forename: Michael B
authors.initials: MB
authors.lastname: Gotway
authors.forename: W Richard
authors.initials: WR
authors.lastname: Webb
authors.forename: Roy L
authors.initials: RL
authors.lastname: Gordon
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Golden
mesh_terms: D003251:Constriction, Pathologic; D016629:Esophagectomy / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D008875:Middle Aged; D015607:Stents; D014057:Tomography, X-Ray Computed; D014132:Trachea / Q000473:pathology* / Q000601:surgery