The use of heterologous bovine pericardium in the surgical treatment of large tracheo-oesophageal fistulas and dilaceration of the membranous wall of the trachea. Case report.

The tracheo-oesophageal fistula is a severe condition endangering the patients' live. The main cause of this condition is the prolonged ventilation. The purpose of this paper is to present an innovative technique in treating this affection. CASE REPORT: We present the case of a 32 years old female patient with multiple trauma due to traffic accident. The patient was hospitalized with the diagnosis of brain injury, subarachnoid hemorrhage, and fractured femur. After 11 days of mechanical ventilation and intubation via endotracheal route, the patient was diagnosed with a large (7x3 cm) tracheo-oesophageal fistula with dilaceration of the membranous wall of the trachea. A cervical and right thoracic approach was performed to repair the tracheo-oesophageal fistula. The reconstruction of the membranous wall of the trachea was performed by using heterologous bovine pericardium patch, and the of the esophageal defect using single-layer suture protected by a heterologous bovine pericardium patch. The postoperative evolution was favorable, the patient being discharged 22 days postoperatively and in good health after 6 months. To our knowledge this is the first reported case regarding the use of two heterologous bovine pericardium in the surgical treatment of large tracheo-oesophageal fistula with dilaceration of the membranous wall of the trachea to reconstruct the membranous wall of the trachea and to protect the esophageal suture. KEY WORDS: Heterologous bovine pericardium, Trachea-oesophageal fistula.

A fatal complication of an incarcerated diaphragmatic hernia Pyo-pneumopericardium due to a gastro-pericardial fistula, case report and literature review.

UNLABELLED: A fatal complication of an incarcerated diaphragmatic hernia: pyo-pneumopericardium due to a gastro-pericardial fistula, case report and literature review INTRODUCTION: The pyo-pneumopericardium is a very rare complication of an incarcerated diaphragmatic hernia. Usually, it depends on the existence of a gastropericardial fistula and, in most cases, it is a deadly complication. CASE REPORT: We present the case of a 65 year old man who was admitted to our emergency service with clinical signs of septic shock. With the help of the CT scan a pyo-pneumopericardium and incarcerated diaphragmatic hernia was diagnosed. He was subjected to emergency surgical intervention with double approach (thoracic and abdominal), discerning during surgery the existence of a pericardial abscess due to a gastro-pericardial fistula due to an incarcerated diaphragmatic hernia. The gastric fundus was resected with abolition of the gastro-pericardial fistula, evacuation of the pericardial abscess, performing the splenectomy (in order to have a better surgical access) and adequate treatment of the diaphragmatic hernia. Despite the medical efforts, the patient died on the 10th postoperative day due to septic complications. To our knowledge this is the first case reported in the literature of gastro-pericardial fistula complicated with pyo-pneumo-pericardium due to an incarcerated diaphragmatic hernia. In such cases we consider that only by performing a double surgical approach (thoracic and abdominal) we can provide a proper resolution of the case, also based on the objective situation found during surgery, where the splenectomy can provide an easier approach to the diaphragmatic hernia.