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Otolaryngologic Clinics of North America Aug 2023Pharyngoesophageal reconstruction is one of the most challenging reconstructive dilemmas that demands extensive planning, meticulous surgical execution, and timely... (Review)
Review
Pharyngoesophageal reconstruction is one of the most challenging reconstructive dilemmas that demands extensive planning, meticulous surgical execution, and timely management of postoperative complications. The main goals of reconstruction are to protect critical blood vessels of the neck, to provide alimentary continuity, and to restore functions such as speech and swallowing. With the evolution of techniques, fasciocutaneous flaps have become the gold standard for most defects in this region. Major complications include anastomotic strictures and fistulae, but most patients can tolerate an oral diet and achieve fluent speech after rehabilitation with a tracheoesophageal puncture.
Topics: Humans; Plastic Surgery Procedures; Laryngectomy; Treatment Outcome; Surgical Flaps; Postoperative Complications; Retrospective Studies
PubMed: 37221117
DOI: 10.1016/j.otc.2023.04.005 -
The American Surgeon Sep 2023Gastrostomy tubes are often placed in patients with poor voluntary intake, oropharyngeal dysphagia, or chronic illness to provide definitive nutritional access. Despite...
Gastrostomy tubes are often placed in patients with poor voluntary intake, oropharyngeal dysphagia, or chronic illness to provide definitive nutritional access. Despite the widespread use of gastrostomy tubes, some patients can experience complications associated with this procedure including gastrocolic-cutaneous fistula and dislodgement of gastrostomy tube. This case discusses an instance of gastrojejunal fistula formation over one year after gastrostomy tube placement likely due to tube dislodgement. Imaging showed gastrostomy tube traversing the posterior wall of the stomach and creating a fistula into the jejunum, with the balloon inflated within the jejunum. Gastrostomy tube was removed and replaced, with gastrostomy tube study showing no extravasation of contrast. Patient is now doing well-tolerating tube feeds at goal.
Topics: Humans; Gastrostomy; Intubation, Gastrointestinal; Enteral Nutrition; Gastric Fistula; Stomach; Intestinal Fistula; Colonic Diseases; Retrospective Studies
PubMed: 37969090
DOI: 10.1177/00031348231157890 -
Case Reports in Gastroenterology 2023The case is about an 87-year-old female. While staying at a facility, she had a fever and abdominal pain and visited our hospital for an up-close examination and...
The case is about an 87-year-old female. While staying at a facility, she had a fever and abdominal pain and visited our hospital for an up-close examination and treatment. An abdominal CT scan revealed gallstones, gallbladder enlargement, and common bile duct stones. Endoscopic retrograde cholangiopancreatography was performed to confirm the presence of common bile duct stones, which were extracted. At that time, she was diagnosed with a duodenal fistula of the gallbladder and underwent surgery in our department. The gallbladder and duodenum were firmly adhered, and gallstones were palpated between the gallbladder and duodenum. The gallbladder was incised at the fundus to check the lumen, and gallstones were lodged in the fistula with the duodenum. After the removal of gallstones, the gallbladder was dissected, and a fistula with the duodenum was identified. After treating the cystic duct, the fistula was removed, and the gallbladder was removed. Because the duodenal wall was fragile due to inflammation and the fistula was large and difficult to close simply, the duodenal bulb was separated with a linear stapler, and the stomach and jejunum were reconstructed with a 25-mm CDH using the Roux-en-Y technique. The patient's postoperative course was good, and she was discharged from the hospital.
PubMed: 37928966
DOI: 10.1159/000531486 -
Annals of Surgery Aug 2023The aim of this study was to explore the incidence, risk factors, clinical course and treatment of perforation and fistula of the gastrointestinal (GI) tract in a large...
OBJECTIVE
The aim of this study was to explore the incidence, risk factors, clinical course and treatment of perforation and fistula of the gastrointestinal (GI) tract in a large unselected cohort of patients with necrotizing pancreatitis.
BACKGROUND
Perforation and fistula of the GI tract may occur in necrotizing pancreatitis. Data from large unselected patient populations on the incidence, risk factors, clinical outcomes, and treatment are lacking.
METHODS
We performed a post hoc analysis of a nationwide prospective database of 896 patients with necrotizing pancreatitis. GI tract perforation and fistula were defined as spontaneous or iatrogenic discontinuation of the GI wall. Multivariable logistic regression was used to explore risk factors and to adjust for confounders to explore associations of the GI tract perforation and fistula on the clinical course.
RESULTS
A perforation or fistula of the GI tract was identified in 139 (16%) patients, located in the stomach in 23 (14%), duodenum in 56 (35%), jejunum or ileum in 18 (11%), and colon in 64 (40%). Risk factors were high C-reactive protein within 48 hours after admission [odds ratio (OR): 1.19; 95% confidence interval (CI): 1.01-1.39] and early organ failure (OR: 2.76; 95% CI: 1.78-4.29). Prior invasive intervention was a risk factor for developing a perforation or fistula of the lower GI tract (OR: 2.60; 95% CI: 1.04-6.60). While perforation or fistula of the upper GI tract appeared to be protective for persistent intensive care unit-admission (OR: 0.11, 95% CI: 0.02-0.44) and persistent organ failure (OR: 0.15; 95% CI: 0.02-0.58), perforation or fistula of the lower GI tract was associated with a higher rate of new onset organ failure (OR: 2.47; 95% CI: 1.23-4.84). When the stomach or duodenum was affected, treatment was mostly conservative (n=54, 68%). Treatment was mostly surgical when the colon was affected (n=38, 59%).
CONCLUSIONS
Perforation and fistula of the GI tract occurred in one out of six patients with necrotizing pancreatitis. Risk factors were high C-reactive protein within 48 hours and early organ failure. Prior intervention was identified as a risk factor for perforation or fistula of the lower GI tract. The clinical course was mostly affected by involvement of the lower GI tract.
Topics: Humans; C-Reactive Protein; Upper Gastrointestinal Tract; Fistula; Disease Progression; Pancreatitis; Intestinal Perforation
PubMed: 35866664
DOI: 10.1097/SLA.0000000000005624 -
Endoscopy Dec 2023
Topics: Humans; Endoscopy, Gastrointestinal; Esophageal Fistula
PubMed: 37433318
DOI: 10.1055/a-2107-2540 -
BMJ Case Reports Jun 2024Bouveret's syndrome is an uncommon cause of gastric outlet obstruction caused by the impaction of large gallstones in the duodenal lumen. The gallstones pass into the...
Bouveret's syndrome is an uncommon cause of gastric outlet obstruction caused by the impaction of large gallstones in the duodenal lumen. The gallstones pass into the duodenal lumen through a cholecystogastric or a cholecystoduodenal fistula. Endoscopic retrieval with or without lithotripsy is the first line of management, often with variable success. We present a case of a woman in her 70s who presented with signs of gastric outlet obstruction and was diagnosed with Bouveret's syndrome with a 5 cm diameter gallstone in the third part of her duodenum. Following several unsuccessful attempts of endoscopic extraction, she underwent successful jejunal enterotomy with fragmentation and extraction of the calculus using an Allis tissue holding forceps. Postoperative recovery was uneventful.
Topics: Humans; Female; Gastric Outlet Obstruction; Gallstones; Aged; Syndrome
PubMed: 38890110
DOI: 10.1136/bcr-2024-261232 -
Indian Journal of Otolaryngology and... Sep 2023Complex pharyngeal defects after tumor resection remain a challenging dilemma for reconstructive plastic surgeons. They often benefit from pedicled or free flaps...
AIMS
Complex pharyngeal defects after tumor resection remain a challenging dilemma for reconstructive plastic surgeons. They often benefit from pedicled or free flaps reconstruction to maintain continuity of the aerodigestive tract and protect the great vessels. While pedicle pectoralis major myocutaneous flaps or supraclavicular flaps have been described, microvascular free flaps have largely replaced the use of pedicle flaps.
MATERIALS AND METHODS
We describe our experience with subtotal and total pharyngeal reconstruction utilizing tubed DIEP (n = 2) and latissimus dorsi free flaps (n = 2). All four patients were smokers and received prior radiation.
RESULTS
All patients were able to resume a regular diet and did not suffer any recipient or donor site complications. There were no fistula or total flap losses.
CONCLUSION
In our experience, DIEP and latissimus dorsi free flaps can serve as a valid alternative to radial forearm, jejunal and anterolateral thigh flaps for pharyngeal reconstruction.
PubMed: 37636787
DOI: 10.1007/s12070-022-03449-8 -
Head & Neck Dec 2023Circumferential pharyngoesophageal defects resulting from total pharyngolaryngectomy are commonly reconstructed using free jejunal (FJ) transfer or an anterolateral...
BACKGROUND
Circumferential pharyngoesophageal defects resulting from total pharyngolaryngectomy are commonly reconstructed using free jejunal (FJ) transfer or an anterolateral thigh (ALT) free flap.
METHODS
We reviewed the medical records of 92 patients with ALT free flaps and 140 who underwent FJ transfer between 2009 and 2022, and compared their surgical outcomes.
RESULTS
Total flap loss occurred in two (2%) and five (4%) patients in the ALT free flap and FJ transfer groups, respectively. Fistula rates were 5% in both groups. Stricture rates were 21% and 5% in the ALT free flap and FJ transfer groups, respectively (p < 0.01). At the 5-year follow-up evaluation, intelligible speech was achieved by 83% and 28% of patients (p < 0.01) in the ALT free flap and FJ transfer groups, respectively.
CONCLUSIONS
Each reconstructive method can be further optimized by proficient surgeons with expertise in the available methods and by considering patient-specific factors and available evidence.
Topics: Humans; Free Tissue Flaps; Pharyngectomy; Plastic Surgery Procedures; Thigh; Treatment Outcome
PubMed: 37755124
DOI: 10.1002/hed.27526