Gastric tube-pericardial fistula: a remote complication of esophageal replacement for long gap esophageal atresia

Ruiz-Elizalde, Alejandro; Haley, Mary Jo; Fisher, Jason C.; Frischer, Jason S.; Zitsman, Jeffrey L.

doi:10.1016/j.jpedsurg.2009.02.010

Cited by 3 publications

(3 citation statements)

References 12 publications

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“…A gastric tube-pericardial fistula was recorded in a GTR case 20 years after initial repair. [ 42 ] Hematemesis due to fistula from anastomotic ulcer was reported in a 22-year-old man of CI. [ 43 ] Redundancy also gained much attention that could worsen reflux and lead to ulceration, mainly because of the reluctance to resect excess colon before final anastomosis and colon elongating more rapidly than child's thorax growth.…”

Section: Discussionmentioning

confidence: 99%

Surgical outcomes of different approaches to esophageal replacement in long-gap esophageal atresia

Liu

Yang²,

Zheng³

et al. 2017

Medicine

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Background:Esophageal replacement (ER) surgery has been widely used in long-gap esophageal atresia (LGEA) over the past few decades. The most commonly used surgical approaches in many pediatric surgical centers include colon interposition (CI), gastric pull-up (GPU), jejunal interposition (JI), and gastric tube reconstruction (GTR). However, there is no systematic evidence on which is the optimal conduit for the native esophagus. The aim of this systematic review was to evaluate the short- and long-term outcomes among these 4 replacement approaches in LGEA cases based on current evidence.Methods:PubMed, Web of Science, Cochrane Library, and EMBASE were searched for relevant literature on November 18 2016. Studies on ER in LGEA were reviewed and selected according to eligibility criteria. We focused on surgical outcomes regarding to different replacement approaches, including postoperative complications and long-term follow-up. Both detailed descriptions of single studies and pooled data analysis were conducted. Data were computed by Reviewer Manager 5.3.Results:Twenty-three studies were included (4 comparative retrospective, 3 prospective, and 16 retrospective) with a total of 593 patients (393 LGEA, 66.3%). The number of patients with available data for analysis was 534 (90.1%), including 127 patients (98 LGEA) of GPU, 335 (223 LGEA) of CI, 45 (all LGEA) of JI, and 27 (all LGEA) of GTR. Follow-up information was provided in 15 studies. Anastomotic leak and stricture, respiratory problems, and gastroesophageal reflux were analyzed as major postoperative complications. Long-term follow-ups were concentrated on growth and feeding conditions.Conclusion:Current evidence on short- and long-term outcomes of ER in LGEA patients was limited, and proper prospective comparative studies were lacking. This present systematic review indicates CI and GPU as comparable and favorable approaches, especially CI in the long-term outcomes. Studies on JI and GTR were limited, which need larger sample size to assess their validity and outcomes.

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Section: Discussionmentioning

confidence: 99%

Surgical outcomes of different approaches to esophageal replacement in long-gap esophageal atresia

Liu

Yang²,

Zheng³

et al. 2017

Medicine

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“…A total of eight cases of gastric tube-pericardial fistulae have been reported so far: four of them occurred after surgery for esophageal cancer [11][12][13][14], three occurred 11-20 years after esophageal replacement surgery for esophageal atresia or corrosive injury in children [15][16][17], and one adult case occurred 8 years after surgery because of esophageal rupture [18]. All nine cases, including the present one, are listed in Table 1.…”

Section: Discussionmentioning

confidence: 90%

Gastropericardial fistula resulting from ulcerative perforation of the reconstructed gastric tube after surgery for esophageal cancer

et al. 2011

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Gastropericardial fistulae are rare and may cause fatal complications such as acute purulent carditis and cardiac tamponade. The present report describes a case of a gastropericardial fistula caused by a peptic ulcer perforating a retrosternal reconstructed gastric tube 2 years after subtotal esophagectomy for esophageal cancer. Surgical intervention involved left thoracotomy, pericardium fenestration, and drainage of the pericardium and left thoracic cavity. The patient suffered postoperative complications including septic shock, acute respiratory distress syndrome, and cardiac insufficiency; however, he recovered after successful surgical intervention. In this case, the withdrawal of proton pump inhibitors and the patient's sustained drinking habit after esophageal replacement surgery may have caused peptic ulcers in the gastric tube. Early diagnosis and surgical treatment of gastropericardial fistulae are essential to avoid fatal complications.

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“…Extirpation of the esophagus and plastic surgery with the isoperistaltic gastric tube are preferred among a variety of methods for reconstruction in benign esophageal disease [10][11][12]. Studying the delayed consequences of esophagogastroplasty revealed a high risk for the development and progression of pathological changes (despite high functional activity of the gastric tube) [4,5,8,13].…”

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confidence: 99%

Ultrastructural Study of Cell Populations in the Gastric Transplant after Esophagoplasty

et al. 2011

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Ultrastructural characteristics of cell populations in the gastric tube mucosa were studied after plastic surgery for benign esophageal disease. The foveolar epithelium mainly consisted of secretory active mucocytes with small changes in cytoplasmic organelles. Functionally immature parietal cells and gland cells in the epithelium of fundal glands were characterized by atrophy and degeneration. Ultrastructural features of the epithelial compartment attest to adaptive cellular hypersecretion of the mucoid against the background of impaired acid production and enzyme secretion. The stromal compartment was characterized by low pinocytotic activity of endothelial cells in blood vessels and polymorphism of smooth muscle cells. Hypertrophic leiomyocytes were shown to dominate in the population of these cells. Some cells had signs of biosynthesis and reduction of filaments. Single leiomyocytes were degenerated. The observed ultrastructural modification of epithelial and connective cells can be interpreted as structural adaptation of the gastric transplant.

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Gastric tube-pericardial fistula: a remote complication of esophageal replacement for long gap esophageal atresia

Cited by 3 publications

References 12 publications

Surgical outcomes of different approaches to esophageal replacement in long-gap esophageal atresia

Surgical outcomes of different approaches to esophageal replacement in long-gap esophageal atresia

Gastropericardial fistula resulting from ulcerative perforation of the reconstructed gastric tube after surgery for esophageal cancer

Ultrastructural Study of Cell Populations in the Gastric Transplant after Esophagoplasty

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