RESUMEN
Gastropleural fistula is a rare complication of prior lung surgery, gastric ulcer, trauma and malignancy. A 62 year old female patient who had received surgical repair of a perforated gastric wall 10 years prior, underwent open pleural decortication. At 4 days after surgery, food residuums were noticed at the chest bottles. Hence, an emergency esophagogram was done. The esophagogram revealed a gastropleural fistula. The patient received a total gastrectomy, intra-abdominal diaphragmatic repair and massive thoracic saline irrigation through a previous thoracic wound. The patient was discharged 11 days after surgery without other morbidity.
Asunto(s)
Femenino , Humanos , Urgencias Médicas , Empiema , Fístula , Gastrectomía , Pulmón , Úlcera Gástrica , Tórax , ÚlceraRESUMEN
We performed nerve resection and reconstruction of the phrenic nerve in a 63-year-old female patient who underwent complete resection of a malignant thymoma. The left phrenic nerve was completely encased by the tumor for 2 cm. Thus, a 3 cm long piece of phrenic nerve with 5 mm margins of safety on each end was resected and it was directly anastomosed in an end-to-end fashion. At 11 months after reconstruction, fluoroscopy demonstrated adequate and symmetric motion of both hemidiaphragms, which indicated the restoration of phrenic nerve function. The pulmonary function test results were comparable to those obtained preoperatively at 30 months. There has been no evidence of recurrence at the recent follow up visits.
Asunto(s)
Femenino , Humanos , Persona de Mediana Edad , Fluoroscopía , Estudios de Seguimiento , Nervio Frénico , Recurrencia , Pruebas de Función Respiratoria , TimomaRESUMEN
A 72-year-old man with progressive, unexplained lower gastrointestinal bleeding presented to the emergency department with abdominal pain and shock. Computed tomography of the abdomen showed a fistula between a right common iliac artery aneurysm and the small intestine. Laparotomy demonstrated a saccular aneurysm of the common iliac artery with a fistulous communication to the terminal ileum. Aneurysmectomy, aortoiliac graft replacement and segmental ileocecal resection with end-to-side anastomosis were all successfully performed. For a patient having an arterioenteric fistula along with lower gastrointestinal bleeding, making an early diagnosis using computed tomography and then performing immediate surgery can be expected to save the patient's life.