Takeda Flavio Roberto, Garcia Rodrigo Nicida, de Lima Marcelo Simas, Yogolare Gustavo Gonçalves, Junior Ulysses Ribeiro, Filho Fauze Maluf, Sallum Rubens Antonio Aissar, Cecconello Ivan
Department of Gastroenterology, Digestive Surgery Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Brazil.
Int J Surg Case Rep. 2020;77:100-103. doi: 10.1016/j.ijscr.2020.10.107. Epub 2020 Oct 28.
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.
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.
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.
Treatment of the association of esophageal cancer and histoplasmosis is feasible. However, care should be taken to avoid highly potential postoperative complications.
食管切除术是一项具有挑战性的手术，会带来相当高的发病率。既往肺部疾病，如组织胞浆菌真菌感染，可能会影响食管切除术后的手术及术后结果。吻合口漏是食管切除术后最令人担忧的并发症之一。然而，已证实诸如负压治疗和食管支架等新疗法是有益的。
我们报告一例年轻患者，患有中段食管鳞状细胞癌且有肺部组织胞浆菌病史。经过多学科会诊后，由于肺部疾病，患者接受了经裂孔食管切除术、胃上提术及颈部吻合术。该患者随后出现吻合口漏并伴有纵隔脓肿。我们描述了通过内镜负压系统、食管支架对该并发症的处理，并展示了说明该技术的视频。
我们阐述了与既往肺部疾病相关的食管癌的处理。组织胞浆菌病可能会误判食管癌分期，并可能导致吻合口漏的发生。内镜负压系统是治疗食管切除术后食管胃吻合口瘘的一种出色工具，即使引流液积聚在纵隔内也是如此。食管支架可在纵隔脓肿消退后使用。
食管癌与组织胞浆菌病并存的治疗是可行的。然而，应注意避免发生高度潜在的术后并发症。
