Patients with impaired diaphragm function are dependent on long-term mechanical ventilation. It is associated with numerous health complications as well as significant economic burden. Intramuscular diaphragm stimulation through laparoscopic implantation of pacing electrodes is a safe method which enables restoring breathing using diaphragm in a considerable number of patients. The first implantation of diaphragm pacing system in the Czech Republic was performed in a thirty-four-year-old patient suffering from a high-level cervical spinal cord lesion. After eight years of mechanical ventilation support, just five months from initiation of stimulation, the patient is able to breathe spontaneously for ten hours per day on average, with expected total weaning. Once the insurance companies decide to reimburse the pacing system, a widespread use of the method even in patients with other diagnoses, including children, is expected.
Aim Graft redundancy and anastomotic stricture after colon interposition are well-known late complications. Cardiac compression by distended colon conduit is uncommon. There is a few reports in the literature. We present a case of 58-year-old patient with a major dilatation of colon conduit occurred 7 years after esophagectomy and gastrectomy. Case report The patient was admitted to district general hospital with 4-hour history of abdominal pain. Chest X- ray and abdominal computer tomography (CT) scan revealed distended colon conduit, pneumomediastinum, small-bowel ileus and pneumoretroperitoneum. An attempt to insert a nasogastric tube failed and an emergency laparotomy was performed. At operation, a band causing small bowel strangulation and adhesions were divided. The bowel appeared viable and a clear perforation was not found. Resection was not necessery. For next 10 hours, progressing hemodynamic instability and sepsis required intravenous vasoactive medication and orotracheal intubation. Chest CT scan showed massive distention of substernal colon conduit with compression of heart and pulmonary arteries. The patient was referred to our institution. Prompt endoscopy was performed with suction of air and liquid content from colon and nasogastric tube was inserted. The colonic mucosa was viable without necrosis and perforation. Hemodynamics improved immediately after decompression of colonic roll. An exploratory laparotomy revealed fatal extensive ischemia infarction of the bowel and the patient died within 4 hours after surgery. Concluson Extrapericardial cardiac tamponade is a rare complication after substernal esophageal reconstruction and could lead to bowel hypoperfusion or ischemia. Early recognition of symptoms and management with conduit decompression are important.
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