ABSTRACT
Anastomotic stricture is a common sequela after primary repair of esophageal atresia with esophagoesophagostomy. Esophageal perforation secondary to dilatation of the stricture, and refractory stricture are not uncommon. We present a case using a Polyflex Airway stent (Boston Scientific, Natick, MA) as an alternative treatment of esophageal stricture and perforation in an infant.
Subject(s)
Esophageal Atresia/surgery , Esophageal Perforation/therapy , Esophageal Stenosis/therapy , Postoperative Complications/therapy , Stents , Coated Materials, Biocompatible , Esophageal Perforation/etiology , Esophageal Stenosis/etiology , Esophagoscopy , Female , Fundoplication/methods , Humans , InfantABSTRACT
Patients in extremis because of trauma-related massive chest injury require expedient evaluation and prompt intervention. The initial pathophysiology relates to the significant intrapulmonary shunting caused by disruption of pulmonary capillaries and extravasation into the alveolar spaces. Disproportionate or unilateral lung involvement needs measures more technical than general supportive care. Independent lung ventilation (mostly with unilateral lung involvement) and other strategies like inhaled nitric oxide, prone positioning, partial liquid ventilation, and extracorporeal membrane oxygenation (ECMO) have had good results. Intensivists confronted with this clinical subset may consider using these strategies as alternative/adjunctive options for optimizing respiratory and hemodynamic status in the supportive management of trauma-related acute lung injury (ALI) and adult respiratory distress syndrome (ARDS).
