Maizlin Ilan Igor, Chen Jerry S, Smith Nicholas James, Rogers David A
Division of Pediatric Surgery, Children's Hospital Of Alabama, University Of Alabama, Birmingham, Alabama, USA.
Am Surg. 2016 Sep;82(9):789-91.
Posttraumatic esophagomediastinal fistula is an uncommon clinical entity that warrants surgical awareness due to its life-threatening potential. Its management, especially in previously operated field, is controversial and several endoscopic methods are being proposed as alternatives. Ours is the first report of endoscopic fulguration and fibrin injection in successful closure of such fistula. A 9-year-old female sustained complete tracheoesophageal transection from a gunshot wound to the neck and underwent immediate primary repair. She presented nine months later with fevers and swelling over anterior neck. CT revealed air tracking posteriorly to the dorsal neck and inferiorly to the mediastinum. Considering difficulty of open surgical approach, endoscopic intervention was attempted. Posterior wall fistula was identified via microlaryngoscopy above the esophageal anastomosis. The fistula tract was de-epithelialized via a Bugbee fulgurating electrode and then sealed with fibrin glue. Consequent imaging studies demonstrated complete occlusion of the fistula. Posterior posttraumatic esophagomediastinal fistula presents a challenging scenario from a surgical standpoint, as it combines difficulty of safe approach, high rate of injury to surrounding structures, and significant postoperative recurrence rate. Endoscopic Bugbee fulguration and fibrin glue injection are a safe and effective alternative to the traditional approach.
创伤后食管纵隔瘘是一种罕见的临床病症，因其具有危及生命的可能性，需要外科医生予以关注。其治疗，尤其是在既往手术区域，存在争议，目前正在提出几种内镜治疗方法作为替代方案。我们首次报道了内镜下电凝和纤维蛋白注射成功闭合此类瘘管的病例。一名9岁女性因颈部枪伤导致气管食管完全横断，并立即接受了一期修复手术。九个月后，她出现发热和颈部前方肿胀。CT显示气体向后追踪至颈背部，向下至纵隔。考虑到开放手术入路的困难，尝试了内镜干预。通过食管吻合口上方的显微喉镜检查发现后壁瘘管。使用Bugbee电凝电极对瘘管进行去上皮化，然后用纤维蛋白胶封闭。随后的影像学检查显示瘘管完全闭塞。从外科角度来看，创伤后食管纵隔后壁瘘是一个具有挑战性的情况，因为它兼具安全入路困难、周围结构损伤率高以及术后复发率高的特点。内镜下Bugbee电凝和纤维蛋白胶注射是传统治疗方法的一种安全有效的替代方案。
