Esophageal Mucocele: A Complication of Blind Loop Esophagus

Kamath, M. Vinayak; Ellison, Robert G.; Rubin, Joseph W.; Moore, H. Victor; Pai, Ganesh P.

doi:10.1016/s0003-4975(10)60609-1

Cited by 40 publications

(42 citation statements)

References 29 publications

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“…Instead, in cases of post-caustic stenosis, the two procedures are disqualified by another problem that should not be neglected: providing a drainage pathway for the stenotic esophagus, often through an eso-jejunal anastomosis that will further complicates the operator's gesture. Not performing the drainage operation (49,50) is likely to lead to the cystic transformation of the mediastinal esophagus with severe complications. An alternative would be subtotal esophageal resection with gastric transposition in mediastinum, but perisophageal fibrotic remodeling is often severe, making the esofagectomy extremely difficult.…”

Section: Discussionmentioning

confidence: 99%

Esophageal Reconstruction with the Stomach, a Functional Dilemma?

Predescu¹,

Constantinoiu²

2018

chr

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RezumatÎn urmă cu câteva decade, substituţia esofagiană se adresa în special cazurilor de stenoze esofagiene postcaustice; actual, reconstrucţia şi-a lărgit paleta indicaţiei şi pentru alte domenii din patologia esofagiană benignă (tulburări motorii severe, acalazie multi-recidivată, stenoze peptice, etc.) dar a devenit şi un timp final cvasi-obligatoriu în exereza esofagiană pentru cancer ori de câte ori gestul este posibil. Tehnicile de reconstrucţie esofagiană ce folosesc potenţialul visceral al stomacului, indiferent de indicaţie şi varianta tehnică aleasă, rămân o metodă valoroasă şi eficace. O serie de argumente redutabile pledează pentru un tip sau altul de grefon gastric: factori anatomici mai mult decât convenabili (vascularizaţie, lungime suficientă, structură parietală competentă pentru sutură, etc.) şi un act operator sustenabil (durată, abord, complexitate timpi operatori, tulburări digestive post-grefare, funcţionalitate postterapeutică, etc). Opţiunea pentru o tehnică sau alta, dincolo de argumente patologice, trebuie să ţină cont de funcţionalitatea la distanţă, cu evident impact pe status-ul metabolic şi calitatea vieţii. Deci putem argumenta funcţional un montaj gastric sau altul funcţie de acest criteriu? În final, dovada unei rezolvări adecvate este relativ facil de apreciat: a fost restabilită deglutiţia şi dacă da, rezultatul s-a menţinut în timp? Pentru cazurile oncologice evaluarea trebuie să ţină seama şi de criteriul cronologic al ratei de supravieţuire postoperatorii. Metodă: Lotul evaluat statistic s-a întins pe perioada 1981 -2016 şi a cuprins un număr de 268 de pacienţi operaţi pentru stenoze esofagiene, repartizaţi în funcţie de etiopatogenie şi indicaţie în 201 de reconstrucţii pentru cauze stenotice post-caustice şi 67 pentru substituţie post-ablativă de cauză neoplazică. Tehnicile utilizate pentru evaluarea funcţională la distanţă au cuprins: prânz radio-opac, ex.endoscopic + biopsie, iar la cazuri cu modificări evidente pH-metrie/24h şi manometrie şi excepţional scintigrafie cu alimente marcate. Rezultate: Au fost identificate două tipuri de probleme: un tip particular de disfuncţie neuromotorie a substitutului esofagian la 6 pacienţi (1 reconstrucţie tip Gavriliu şi 5 cu tot stomacul Nakayama), evacuarea grefonului fiind dificilă, întârziată, cu stază importantă şi disconfort alimentar (vărsături, inabilitatea alimentaţiei, fenomene aspirative) respectiv o patologie de reflux -8 bolnavi, fiind argumentată de o simptomatologie specifică, de prînzul baritat, de examenul endoscopic şi de examen-ul pH-metric. Refluxul avea un caracter alcalin la 7 pacienţi, toţi cu piloroplastie, 5 cu tot stomacul şi 2 cu procedeu Akiyama iar la 1 caz cu procedeu Gavriliu refluxul era acid. Concluzii: Stomacul este o obţiune redutabilă în substituţia esofagiană. În ceea ce priveşte rezultatele la distanţă se constată o funcţionalitate bună, cu un status metabolic rezonabil. Cele două fenomene de care depinde funcţional grefonul -activitate secretorie şi activitate motorie -par a se restabili odată...

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Section: Discussionmentioning

confidence: 99%

Esophageal Reconstruction with the Stomach, a Functional Dilemma?

Predescu¹,

Constantinoiu²

2018

chr

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“…The incidence of esophageal mucoceles after esophageal bypass surgery is over 40% [1] and most develop within the first 2 months after surgery [1,6]. Most esophageal mucoceles are non-progressive and asymptomatic, because the increasing intraluminal pressure causes atrophy of the esophageal glands, resulting in a decrease of the esophageal secretion volume [1,2,10]. Only in rare instances do they progressively enlarge and compress the airway, causing respiratory symptoms such as coughing, dyspnea, and respiratory distress [2][3][4][5].…”

Section: Discussionmentioning

confidence: 99%

“…Most esophageal mucoceles are non-progressive and asymptomatic, because the increasing intraluminal pressure causes atrophy of the esophageal glands, resulting in a decrease of the esophageal secretion volume [1,2,10]. Only in rare instances do they progressively enlarge and compress the airway, causing respiratory symptoms such as coughing, dyspnea, and respiratory distress [2][3][4][5]. Most such cases tend to present with symptoms from 4 months to 4 years after esophageal exclusion [12,[14][15][16][17][18].…”

Section: Discussionmentioning

confidence: 99%

“…Most esophageal mucoceles remain progression-free and asymptomatic, but in rare instances they can progressively enlarge and compress the airway, causing respiratory symptoms [2][3][4][5]. Complete resection of the mucoceles via thoracotomy is recommended for treatment of symptomatic esophageal mucoceles, because it is believed there is a greater risk of relapse of the mucoceles and development of complications after simple drainage of the contents [2,4,[6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

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A symptomatic esophageal mucocele after esophageal bypass surgery

et al. 2012

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We encountered a case of esophageal mucocele with progressive respiratory symptoms which originated from an excluded thoracic esophagus that was closed at both the proximal and distal ends, and which occurred 24 years after esophageal bypass surgery for a spontaneous esophageal rupture. The patient was a 64-year-old male who was treated by a temporary external drainage for relief of his symptoms without subsequent complete resection of the mucocele via thoracotomy, because of the high surgical risks associated with such a procedure. Four-hundred and fifty milliliters of waste removed during the initial external drainage showed no signs of inflammation or malignancy, suggesting that the reason this excluded esophagus was a symptomatic mucocele was not the observed vigorous secretion, because of irritated esophageal mucosal cells or malignant cells, but instead was the result of gradual accumulation of secretions from the normal esophageal mucosa. This case suggests that an excluded esophagus without any inflammation or malignancy could form a large mucocele that can cause serious symptoms, for example respiratory difficulty, even after an extremely long interval. Although he has been both relapse-free and drainage-free for more than 5 years, further long-term follow-up in this case is mandatory.

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“…Surgical interruption of the esophagus and intrathoracic gastric interposition are performed for treatment of esophageal carcinoma, stricture, and functional disorders causing persistent dysphagia or aspiration [1]. When the esophagus is bypassed, the excluded segment may retain intraluminal secretions and form an intrathoracic mucocele [2].…”

mentioning

confidence: 99%

Mucocele of the surgically isolated esophagus

Gelderen

1993

Abdom Imaging

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A large esophageal mucocele causing chest pain developed in a 26-year-old woman who had undergone esophageal bypass surgery and gastric interposition because of involvement by scleroderma. Computed tomographic (CT) scans showed the mucocele as an elongated mediastinal mass which spontaneously reduced in size during conservative management. The clinical and radiological features of this unusual postsurgical complication are herein reviewed.

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Esophageal Mucocele: A Complication of Blind Loop Esophagus

Cited by 40 publications

References 29 publications

Esophageal Reconstruction with the Stomach, a Functional Dilemma?

Esophageal Reconstruction with the Stomach, a Functional Dilemma?

A symptomatic esophageal mucocele after esophageal bypass surgery

Mucocele of the surgically isolated esophagus

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