Dataset Information

Esophagectomy in a patient with pulmonary histoplasmosis: A case report of surgical aspects and complications (with video).

ABSTRACT:

Introduction

Esophagectomy is a challenging procedure associated with considerable morbidity. Previous pulmonary diseases, such as histoplasmosis fungal infection, may interfere in operative and postoperative outcomes after esophagectomy. Anastomotic leakage is one of the most feared complications after esophagectomy. However, new therapies developed such as vacuum procedure and esophageal prosthesis have been provenly beneficial.

Presentation of case

We present a case with squamous cell carcinoma of the mid esophagus portion on a young patient with a pulmonary histoplasmosis history. After a multidisciplinary board, the patient underwent transhiatal esophagectomy with gastric-pull up and cervical anastomosis due to pulmonary disease. The patient later developed an anastomotic leak with mediastinal abscess. We describe this complication's management via an endoscopic vacuum system, esophageal prosthesis, and exhibit a video illustrating the technique.

Discussion

We illustrate the management of esophageal cancer associated with previous pulmonary disease. Histoplasmosis may misunderstand the esophageal cancer staging, and it can contribute to anastomotic leakage occurrence. An endoscopic vacuum system is an excellent tool for treating esophagogastric anastomosis fistula after esophagectomy, even when the drainage is accumulated in the mediastinum. The esophageal prosthesis may be used after mediastinal abscess resolution.

Conclusion

Treatment of the association of esophageal cancer and histoplasmosis is feasible. However, care should be taken to avoid highly potential postoperative complications.

SUBMITTER: Takeda FR

PROVIDER: S-EPMC7649434 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Publications

Esophagectomy in a patient with pulmonary histoplasmosis: A case report of surgical aspects and complications (with video).

Takeda Flavio Roberto FR Garcia Rodrigo Nicida RN de Lima Marcelo Simas MS Yogolare Gustavo Gonçalves GG Junior Ulysses Ribeiro UR Filho Fauze Maluf FM Sallum Rubens Antonio Aissar RAA Cecconello Ivan I

International journal of surgery case reports 20201028

<h4>Introduction</h4>Esophagectomy is a challenging procedure associated with considerable morbidity. Previous pulmonary diseases, such as histoplasmosis fungal infection, may interfere in operative and postoperative outcomes after esophagectomy. Anastomotic leakage is one of the most feared complications after esophagectomy. However, new therapies developed such as vacuum procedure and esophageal prosthesis have been provenly beneficial.<h4>Presentation of case</h4>We present a case with squamo ...[more]

PMID: 33160165

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Project description:Introduction and importance Pancreatic body and tail adenocarcinoma is a tumor of silent evolution, showing up as advanced disease at diagnosis in the majority cases. Case presentation A 60-year-old man, presenting a solid expansive lesion (3.1 × 2.8 cm) in the body of the pancreas, by imaging exams. There was 50% involvement of the celiac trunk at the level of the it's bifurcation and suspected peripancreatic lymph nodes. Clinical staging was cT4N1M0. After neoadjuvant chemotherapy (NQT), there was a small reduction of the tumor to 3.0 × 2.6 cm, an important decreasing of the celiac trunk involvement (25%), and also a reduction in the levels of C19–9 from 650 U/mL to 358 U/mL. Further on, the patient underwent a Robotic Modified Appleby procedure, without intra and postoperative complications. Clinical discussion Locally advanced pancreatic tumors should be referred to NQT, and those with good response might benefit to radical surgery. The modified Appleby technique - distal pancreatectomy with splenectomy and celiac trunk resection – is the procedure of choice when there is involvement of celiac trunk, but concern must be given to the liver vascularization. The use of robotic system on pancreatic surgery is emerging, but still, there is lower data regarding its safety in major pancreatic procedures. Conclusion The use of neoadjuvant therapy is recommended to assess the in vivo response, improve oncological results and increase negative margins. Pre-operative imaging is mandatory for surgical planning. The robotic modified Appleby procedure is feasible and safe, with reduced of intraoperative blood loss and transfusion rate, corroborating the literature. Highlights • 30% of pancreatic cancer presents as locally advanced disease at diagnosis with invasion to vascular structures.• Arterial involvement is the biggest challenge for oncological resection, and involvement of the celiac axis or its branches can make curative resection impossible• Robotic systems have been used in pancreatic surgery, but there is fewer data regarding feasibility and safety in major procedures.• Preoperative radiology is crucial to assess the response to neoadjuvant therapy and allows for the analysis of vascular anatomy.

Dataset Information

Esophagectomy in a patient with pulmonary histoplasmosis: A case report of surgical aspects and complications (with video).

Introduction

Presentation of case

Discussion

Conclusion

Publications

Esophagectomy in a patient with pulmonary histoplasmosis: A case report of surgical aspects and complications (with video).

Similar Datasets

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