Successful Closure of Postoperative Esophagobronchial Fistula With Amplatzer Vascular Plug Mingli Sun, MD, PhD, Runduo Pan, MD, Xianglei Kong, MD, and Dianbo Cao, MD, PhD Department of Intensive Care Unit and Department of Radiology, The First Hospital of Ji Lin University, Chang Chun, China
A
Address correspondence to Dr Cao, Department of Radiology, The First Hospital of Jilin University, No. 71 Xin Min Street, Chang Chun, 130021, China; e-mail: [email protected].
Ó 2015 by The Society of Thoracic Surgeons Published by Elsevier
FEATURE ARTICLES
48-year-old man with a history of esophageal carcinoma underwent esophagectomy with gastroesophageal anastomosis. Postoperative esophagobronchial fistula was found 2.5 years before because of persistent high fever. Various treatments, including total parental nutrition together with antibiotics, were tried without success. Subsequently, an intraluminal esophageal stent was placed in the esophagus (Fig 1A), but failed to cover the fistula orifice because of stent migration within a short period. A jejunostomy had to be created for enteral nutrition purposes. The patient had been suffering from fistula-related pulmonary infection for more than 2 years before closure by this procedure. Based on the chronic nature of this esophagobronchial fistula and normal appearing esophageal mucosa at the fistula orifice on endoscopic imaging (Figs 1B, 1C), closure with Amplatzer vascular plug (AVP) was considered. Using fluoroscopic guidance and direct visualization with fiberoptic endoscopy, AVP was successfully delivered into the esophagobronchial fistula tract. Intraoperatively, the proximal disc of AVP was fully expanded, but the distal half of the plug showed incomplete expansion. Esophagogram obtained 4 days after the procedure showed complete closure of the esophagobronchial fistula (Fig 1D) and delayed full expansion of the distal half of AVP. Sixmonth follow-up imaging showed no signs of recurrence of the esophagobronchial fistula.
Fig 1.
In summary, esophagobronchial fistula remains a potentially life-threatening postesophagectomy complication. Closure with AVP under fluoroscopic guidance and direct visualization with fiberoptic endoscopy can be an alternative treatment for refractory esophagobronchial fistulas.
Ann Thorac Surg 2015;99:1453 0003-4975/$36.00 http://dx.doi.org/10.1016/j.athoracsur.2014.11.070
A
Address correspondence to Dr Cao, Department of Radiology, The First Hospital of Jilin University, No. 71 Xin Min Street, Chang Chun, 130021, China; e-mail: [email protected].
Ó 2015 by The Society of Thoracic Surgeons Published by Elsevier
FEATURE ARTICLES
48-year-old man with a history of esophageal carcinoma underwent esophagectomy with gastroesophageal anastomosis. Postoperative esophagobronchial fistula was found 2.5 years before because of persistent high fever. Various treatments, including total parental nutrition together with antibiotics, were tried without success. Subsequently, an intraluminal esophageal stent was placed in the esophagus (Fig 1A), but failed to cover the fistula orifice because of stent migration within a short period. A jejunostomy had to be created for enteral nutrition purposes. The patient had been suffering from fistula-related pulmonary infection for more than 2 years before closure by this procedure. Based on the chronic nature of this esophagobronchial fistula and normal appearing esophageal mucosa at the fistula orifice on endoscopic imaging (Figs 1B, 1C), closure with Amplatzer vascular plug (AVP) was considered. Using fluoroscopic guidance and direct visualization with fiberoptic endoscopy, AVP was successfully delivered into the esophagobronchial fistula tract. Intraoperatively, the proximal disc of AVP was fully expanded, but the distal half of the plug showed incomplete expansion. Esophagogram obtained 4 days after the procedure showed complete closure of the esophagobronchial fistula (Fig 1D) and delayed full expansion of the distal half of AVP. Sixmonth follow-up imaging showed no signs of recurrence of the esophagobronchial fistula.
Fig 1.
In summary, esophagobronchial fistula remains a potentially life-threatening postesophagectomy complication. Closure with AVP under fluoroscopic guidance and direct visualization with fiberoptic endoscopy can be an alternative treatment for refractory esophagobronchial fistulas.
Ann Thorac Surg 2015;99:1453 0003-4975/$36.00 http://dx.doi.org/10.1016/j.athoracsur.2014.11.070
