Tracheal compression by the stomach following gastric pull-up: diagnosis with CT and treatment with expandable metallic stent placement.
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.
Kim
Suil
S
Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, CA 94143-0359, USA.
Gotway
Michael B
MB
Webb
W Richard
WR
Gordon
Roy L
RL
Golden
Jeffrey A
JA
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