Delayed Bleeding of Coronary Artery after Thoracoscopic Intradiaphragmatic Bronchogenic Cyst Resection.

Bronchogenic cyst occurring in the diaphragm is rare and thoracoscopic cyst resection is mainly effective treatment. The coronary artery bleeding after video-assisted thoracoscopic surgery (VATS) has never been described; here we report a case of left coronary artery injury after thoracoscopic itradiaphragmatic bronchogenic cyst resection, which may be caused by metallic troca or chest tube.

Analysis of risk factors and classification of aortic fistula after esophagectomy.

BACKGROUND: Aortic fistula after esophagectomy is a rare and serious complication. The aims of this study were to describe the causes of and classify the fistulas. MATERIALS AND METHODS: Between January 2008 and December 2017, a total of 1018 patients underwent esophageal resection, mainly for esophageal cancer; aortic fistula after esophagectomy was diagnosed in four patients. We perform a literature review through a database search for similar cases. Aortic fistulas may be classified into two types based on the site at which they occur in relation to the alimentary tract and area of anastomosis. Type 1 fistula occurs within the area of anastomosis, whereas type 2 fistula occurs above or below the anastomosis. The risk factors and clinical features associated with aortic fistulas are described, and comparison between the two types is made. RESULTS: Through a literature search, 39 cases were identified, of which 26 cases were classified as type 1, and 13 cases were classified as type 2. Of 13 patients (33.3%) who underwent emergent intervention, seven patients survived. Approximately 76.9% of aortic fistula were related to anastomotic fistula, which was more prevalent in type 1 aortic fistula than in type 2 (92% versus 50%, P = 0.005). There was no statistically significant difference in age, gender, side of thoracotomy, type of anastomosis, the postoperative day the hemorrhage occurred, warning hemorrhage, chest pain, or the outcome between the two types of fistula. CONCLUSIONS: Anastomotic fistula is the primary cause of type 1 aortic fistula after esophagectomy, and early diagnosis and intervention of aortic fistula can improve prognosis. This classification may be a useful guide in determining the approach for second-stage alimentary tract reconstruction.

Lobectomy for lung cancer by video-assisted thoracic surgery in situs inversus.

A 62-year-old man with situs inversus totalis and non-small-cell lung cancer underwent a right lower lobectomy by video-assisted thoracoscopic surgery. Lobectomy in a situs inversus totalis patient can be performed safely using this minimally invasive procedure. Preoperative evaluation of the pulmonary artery and veins by three-dimensional computed tomography and the bronchial tree by bronchoscopy, is essential to avoid unanticipated complications during the procedure.