Paraplegia after surgery of the thoracic esophagus

Abstract

Paraplegia after thoracic surgery is an uncommon complication, [1][2][3][4] and it is even more uncommon after surgery of the thoracic esophagus. Herein we describe 2 cases that occurred in our experience.Clinical summaries CASE 1. A 72-year-old man was admitted for the treatment of worsening dysphagia. Barium swallow and esophagogastroscopy revealed a mass 31 cm from the incisors, and the biopsy results showed squamous carcinoma. There was no evidence of locoregional spread or metastases at endosonography and computed tomographic scan. The examination revealed a 3.5-cm abdominal aortic aneurysm and diffuse signs of atherosclerosis. The patient underwent an intrathoracic esophagogastroplasty through a left thoracophrenolaparotomy. Tumor dissection necessitated the interruption of some vessels. No perigastric or mediastinal lymph nodes appeared to be involved. The early postoperative period was uneventful apart from a mild paresthesia of the lower limbs. After 24 hours he suddenly became unable to move his legs. Reflexes were totally absent below the T10-11 level. Multiorgan failure progressively developed and he died 7 days later. Postmortem examination showed a normal appearance of the anastomosis and of the tubulized stomach. An ischemic trait of the spinal cord at the T12-L1 level was also evident.CASE 2. A 58-year-old man was referred for treatment of a 5mm vegetating lesion that resulted in an infiltrating squamous cell carcinoma situated 27 cm from the upper incisors. Endosonography and computed tomographic scan did not show local infiltration or metastases. Esophagectomy was accomplished by blunt dissection, and tubulized stomach was anastomosed at the cervical level. No difficulties were found in gastric preparation and esophageal dissection. The early postoperative period was normal. After 38 hours, the patient began exhibiting a progressive sensory and motor deficit of the lower limbs originating at T6-T7. Magnetic resonance imaging showed an ischemic lesion of the spinal cord and excluded external compression. Apart from neurologic conditions, recovery was rapid. Despite continued medical and rehabilitative treatment, neurologic status was unchanged at 2 years.

What’s new in the pathology, pathophysiology and management of benign esophageal disorders?

“…Finally, esophageal surgery is not without potentially serious complications. Mineo et al 499 describe paraplegia and Levitt et al 500 describe intraoperative cardiac tamponade, successfully treated.…”

Ischemic spinal cord syndrome after transthoracic esophagectomy: two cases of a rare neurologic complication

“…Neurologic deficits resulting from spinal cord ischemia are very rare complications of esophagectomy and are probably often not diagnosed because of an unawareness of this entity 1 . They present with a pattern of neurologic deficits dependent upon the occluded vessel.…”

“…Neurologic de®cits resulting from spinal cord ischemia are very rare complications of esophagectomy and are probably often not diagnosed because of an unawareness of this entity. 1 They present with a pattern of neurologic de®cits dependent upon the occluded vessel. The anterior spinal artery syndrome (ASAS) as a sequela of occlusion of the anterior spinal artery is the most frequently described entity of this group.…”

Paraplegia after esophagectomy: Who are the patients at risk?

“…A review of the world literature since 1966 showed that only 4 such cases have been reported. [1][2][3] We add a fifth case, that of a patient who was referred to our institution for follow-up after resection of adenocarcinoma of the…”