Ann Thorac Surg 2007;84:1767. doi:10.1016/j.athoracsur.2006.11.008
© 2007 The Society of Thoracic Surgeons
Images in Cardiothoracic Surgery
Esophageal Stent Displacement in Left Main Bronchus
Marco Anile, MD*,
Federico Francioni, MD,
Daniele Diso, MD,
Sokratis Tsagkaropoulos, MD,
Valeria Liparulo, MD,
Chiara Ricella, MD,
Federico Venuta, MD
Department of Thoracic Surgery, University of Rome La Sapienza, Rome, Italy
* Address correspondence to Dr Anile, University of Rome La Sapienza, Department of Thoracic Surgery, Viale del Policlinico 155, Rome, 00161, Italy (Email: m.anile{at}virgilio.it).
A 66-year-old woman (who had undergone a complete right mastectomy and radiotherapy 15 years prior for breast cancer) was admitted to the hospital with dyspnea and dysphagia. The chest roentgenogram showed a massive right pleural effusion with positive cytology for recurrence of breast cancer. Thus she successfully underwent talc slurry. Furthermore, esophagogastroscopy was performed and a middle-third esophageal stenosis was revealed. Multiple biopsies at the level of stricture demonstrated an infiltration by pleural carcinomatosis. In the first instance she underwent balloon dilation, but because of the stenosis recurrence, a self-expandable Wall stent (Schneider Inc, Minneapolis, MN) prosthesis was finally inserted with complete remission of symptoms. After 6 months she was newly admitted at the hospital with weight loss, dysphagia, fever, dyspnea, and persistent and productive cough. A computed tomographic scan showed a left pleural effusion, an occlusion of the esophageal stent, and a fistula between the trachea and the esophageal stent (Fig 1). A flexible fiber optic bronchoscopy was performed and confirmed the displacement of the esophageal stent at the level of the left tracheobronchial angle (Fig 2). Therefore, because the displaced stent was not removable, the esophageal exclusion was performed and the alimentary tract continuity was re-established with a subcutaneous colon bypass. The postoperative course was characterized by left lung pneumonia that was solved with repeated airway toilette and antibiotic therapy. She was discharged from the hospital after 1 month in good condition, except for a cough, and she is alive at last follow-up after 3 months. The esophageal perforation by a self-expandable stent is a well-reported complication with an incidence between 2.6% and 10.6% [1]. The more frequent localization is in the proximal third above the carina, although our article describes an unusual site for the fistula.
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References
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- Wang MQ, Sze DY, Wang ZP, Wang ZQ, Gao YA, Dake, MD. Delayed complications after esophageal stent placement for treatment of malignant esophageal obstructions and esophagorespiratory fistulas J Vasc Interv Radiol 2001;12:465-474.[Medline]
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