Delayed fistulization from esophageal replacement surgery.
We present two patients who developed delayed fistulization following esophageal replacement surgery. The first is a 13-year-old child who, at the age of 3 years, underwent a trans-mediastinal colonic esophageal replacement for a refractory corrosive injury followed by a retrosternal reverse gastric tube after an early catastrophic leak. Ten years later, he presented with a history of intermittent chest pain for 6 months. He developed a tension pneumo-pericardial tamponade caused by a fistula between gastric tube and pericardium. He recovered after sternotomy. The second was born prematurely with type C esophageal atresia and other malformations. After esophageal anastomosis, he developed a refractory stricture that was resected at 10 months. Despite a fundoplication at 4 years, the recurrent esophageal stricture required resection at 14 years, accomplished by mobilizing the stomach into the chest through a left thoracoabdominal incision. The postoperative course was complicated by a gastric leak in the chest with empyema, but the patient recovered and was able to eat. Five years later, he underwent an anterior spinal fusion to correct a worsening kyphoscoliosis. Postoperatively, he developed an ARDS picture, leakage of air through the gastrostomy, and a fatal pulmonary hemorrhage secondary to a gastro-bronchial fistula. Fistulization from esophageal replacement surgery represents a rare long-term complication that pediatric surgeons need to be aware of.
Section of Pediatric Surgery, King AbdulAziz Medical City, Jeddah, Kingdom of Saudi Arabia. dr4a@yahoo.com
Ahmed
A
Abdalwahab
Mohammed
M
Al Namshan
Abdullah
A
Al Rabeeah
Jean-Martin
JM
Laberge
D000293:Adolescent; D000328:Adult; D001983:Bronchial Fistula / Q000209:etiology* / Q000601:surgery; D002057:Burns, Chemical / Q000601:surgery; D002424:Caustics / Q000009:adverse effects; D003106:Colon / Q000637:transplantation*; D013505:Digestive System Surgical Procedures / Q000379:methods; D004933:Esophageal Atresia / Q000601:surgery; D004937:Esophageal Fistula / Q000209:etiology* / Q000601:surgery; D004940:Esophageal Stenosis / Q000139:chemically induced / Q000601:surgery; D004944:Esophagoplasty / Q000009:adverse effects* / Q000379:methods; D017809:Fatal Outcome; D005743:Gastrectomy / Q000009:adverse effects*; D005747:Gastric Fistula / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007738:Kyphosis / Q000601:surgery; D008297:Male; D019651:Plastic Surgery Procedures; D016896:Treatment Outcome
D002424:Caustics