Gastrobronchial Fistula after Robotic Repair of Traumatic Diaphragmatic Hernia

Tung, Jamie; Lucero, Leah; Davis, James W.; Sue, Lawrence P.

doi:10.1155/2020/8085425

Cited by 2 publications

(3 citation statements)

References 11 publications

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“…The diagnosis of gastrobronchial fistulas can be very difficult owing to the variation in the clinical presentation and the scarcity of the disease. CT scan with or without oral contrast medium, gastrografin swallow, gastroscopy, and bronchoscopy are suggested diagnostic tools [ 4 , 7 ]. In our patient, the fistula was clearly identifiable on CT even without the administration of oral contrast.…”

Section: Discussionmentioning

confidence: 99%

“…The most common cause for this disease is bariatric surgery, especially sleeve gastrectomy [ 4 – 6 ]. Although the exact pathophysiologic mechanism of the emergence of the disease is not clear, gastroesophageal fistulas are thought to arise from chronic erosion between the lung and the stomach tissue [ 7 ]. In addition, the fistula formation can be triggered by local recurrent or chronic inflammation or abscess.…”

Section: Discussionmentioning

confidence: 99%

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Surgical Repair of a Traumatic Gastrobronchial Fistula

et al. 2022

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Objective:Rare disease Background:Gastrobronchial fistulas mostly occur as a result of postoperative complications, including those of bariatric, esophageal, and spleno-pancreatic surgery. Other causes are pneumonia, neoplasm, gastric ulcer, and subphrenic abscess. Traumatic fistulous communications between the stomach and the lung tissue are rare, with only 8 cases reported in the English-language literature (PubMed search) until now. Case Report:We report a 49-year-old female patient with a gastrobronchial fistula secondary to diaphragm rupture 7 years prior, with intrathoracic herniation of the gastric fundus. She underwent thoracotomy for surgical repair. She presented in our Emergency Department with recurrent hemoptysis and painful cough. The diagnosis of the gastrobronchial fistula was confirmed by computed tomography and simultaneous bronchoscopy and esophagogastroscopy, with injection of toluidine blue. As a multidisciplinary team, we opted for surgical repair owing to the fistula extent and severity and the need of repair of the diaphragm hernia. The patient underwent leftsided thoracoscopy. However, owing to dense adhesions and chronic inflammation, we converted to an open procedure. The herniated gastric fundus was repaired by wedge resection. The affected lung tissue was debrided and reconstructed by suture repair. The diaphragmatic defect was closed by sutures with mesh augmentation. The patient's postoperative course was uncomplicated, and she was discharged in good clinical condition on postoperative day 7. Conclusions:Owing to the scarcity of the disease, the management of a gastrobronchial fistula is not standardized. The establishment of the diagnosis of the disease is often challenging. Therapeutic options include conservative measures, endoscopic options, and surgical repair. Our case showed that a multidisciplinary workup is essential for successful treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Surgical Repair of a Traumatic Gastrobronchial Fistula

et al. 2022

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“… 3 Two reports highlight the robotic repair of chronic TDH; however, one describes the transthoracic approach, whereas the other describes a transabdominal approach complicated by a gastrobronchial fistula as a result of technical error during TDH repair. 4 , 5 We present details for the transabdominal robotic repair of chronic right-sided TDH with technical strategies used to avoid complications ( Video 1 ). We planned a complete abdominal approach, but the right chest was exposed and accessible in case thoracoscopic access became necessary.…”

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confidence: 99%