Multi-disciplinary treatment of broncho-esophageal fistula in a high-risk single-lung patient
Abstract Background A broncho-esophageal fistula (BEF) is a medical and surgical disaster. Treatment of BEF is often limited to palliative stent treatment that may migrate or cause erosions and tissue necrosis. Surgical repair of BEF is the only established definite treatment. Case presentation BEF...
Saved in:
| Main Authors: | , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2025-01-01
|
| Series: | Journal of Cardiothoracic Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13019-024-03287-5 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1841544314637778944 |
|---|---|
| author | Rune Haaverstad Kjell Ovrebo Lorentz Sandvik Håvard Seland Gunnar Reksten Husebø Vegard Skalstad Ellensen Marit Farstad Eivind Strandenes Rajinder Sharma Marianne Øksnes Anders Kjellevold Storesund Solveig Moss Kolseth |
| author_facet | Rune Haaverstad Kjell Ovrebo Lorentz Sandvik Håvard Seland Gunnar Reksten Husebø Vegard Skalstad Ellensen Marit Farstad Eivind Strandenes Rajinder Sharma Marianne Øksnes Anders Kjellevold Storesund Solveig Moss Kolseth |
| author_sort | Rune Haaverstad |
| collection | DOAJ |
| description | Abstract Background A broncho-esophageal fistula (BEF) is a medical and surgical disaster. Treatment of BEF is often limited to palliative stent treatment that may migrate or cause erosions and tissue necrosis. Surgical repair of BEF is the only established definite treatment. Case presentation BEF presented in a 40-year-old female patient 8 years after curative treatment with pneumonectomy and radio-chemotherapy for advanced lung cancer. She had autoimmune comorbidity, a single lung, vocal cord paralysis and an extremely hostile thorax. Multi-disciplinary collaboration, close patient involvement and evaluation by the hospital medical ethics committee were key elements in the following treatment course. After temporary stent treatment, a carefully staged surgical marathon was performed: Veno-venous ECMO was established to secure oxygenation, and bilateral thoracotomy and laparotomy performed to access structures in the frozen mediastinum. After extensive thoracoplasty and high-risk dissection, esophagectomy was performed and the 20 × 35 mm bronchial defect repaired by bronchoplasty with a latissimus muscle flap. It was complicated by thrombotic occlusion of the upper venous system, repeated postoperative bleedings and critical illness neuropathy. The patient recovered and was discharged 150 days after surgery. Within 1–2 years bronchoscopy showed a smooth undiscernible bronchoplasty with a stable open left main bronchus. At 5 years the patient lives an independent life at home with her family. Conclusions Surgical treatment of BEF in an extremely complex patient may turn out successfully. It demands careful ethical considerations, comprehensive surgical strategy, multi-disciplinary teamwork, and shared decision making with the patient. The patient presented in this case report is closely followed up with good life quality after 5 years. |
| format | Article |
| id | doaj-art-c955ff8a1c81418dba06aa8d97e0ab53 |
| institution | Kabale University |
| issn | 1749-8090 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Cardiothoracic Surgery |
| spelling | doaj-art-c955ff8a1c81418dba06aa8d97e0ab532025-01-12T12:39:14ZengBMCJournal of Cardiothoracic Surgery1749-80902025-01-012011610.1186/s13019-024-03287-5Multi-disciplinary treatment of broncho-esophageal fistula in a high-risk single-lung patientRune Haaverstad0Kjell Ovrebo1Lorentz Sandvik2Håvard Seland3Gunnar Reksten Husebø4Vegard Skalstad Ellensen5Marit Farstad6Eivind Strandenes7Rajinder Sharma8Marianne Øksnes9Anders Kjellevold Storesund10Solveig Moss Kolseth11Section of Cardiothoracic Surgery, Department of Heart Disease, Haukeland University HospitalDepartment of Surgery, Haukeland University HospitalDepartment of Otolaryngology, Head and Neck Surgery, Haukeland University HospitalDepartment of Plastic and Reconstructive Surgery, Haukeland University HospitalDepartment of Thoracic Medicine, Haukeland University HospitalSection of Cardiothoracic Surgery, Department of Heart Disease, Haukeland University HospitalDepartment of Anaesthesia and Intensive Care, Haukeland University HospitalDepartment of Plastic and Reconstructive Surgery, Haukeland University HospitalDepartment of Thoracic Medicine, Haukeland University HospitalDepartment of Medicine, Haukeland University HospitalDepartment of Thoracic Medicine, Haukeland University HospitalSection of Cardiothoracic Surgery, Department of Heart Disease, Haukeland University HospitalAbstract Background A broncho-esophageal fistula (BEF) is a medical and surgical disaster. Treatment of BEF is often limited to palliative stent treatment that may migrate or cause erosions and tissue necrosis. Surgical repair of BEF is the only established definite treatment. Case presentation BEF presented in a 40-year-old female patient 8 years after curative treatment with pneumonectomy and radio-chemotherapy for advanced lung cancer. She had autoimmune comorbidity, a single lung, vocal cord paralysis and an extremely hostile thorax. Multi-disciplinary collaboration, close patient involvement and evaluation by the hospital medical ethics committee were key elements in the following treatment course. After temporary stent treatment, a carefully staged surgical marathon was performed: Veno-venous ECMO was established to secure oxygenation, and bilateral thoracotomy and laparotomy performed to access structures in the frozen mediastinum. After extensive thoracoplasty and high-risk dissection, esophagectomy was performed and the 20 × 35 mm bronchial defect repaired by bronchoplasty with a latissimus muscle flap. It was complicated by thrombotic occlusion of the upper venous system, repeated postoperative bleedings and critical illness neuropathy. The patient recovered and was discharged 150 days after surgery. Within 1–2 years bronchoscopy showed a smooth undiscernible bronchoplasty with a stable open left main bronchus. At 5 years the patient lives an independent life at home with her family. Conclusions Surgical treatment of BEF in an extremely complex patient may turn out successfully. It demands careful ethical considerations, comprehensive surgical strategy, multi-disciplinary teamwork, and shared decision making with the patient. The patient presented in this case report is closely followed up with good life quality after 5 years.https://doi.org/10.1186/s13019-024-03287-5Bronchial stentBroncho-esophageal fistulaBronchoplastyEsophagectomyEsophageal stentNon-small lung cancer |
| spellingShingle | Rune Haaverstad Kjell Ovrebo Lorentz Sandvik Håvard Seland Gunnar Reksten Husebø Vegard Skalstad Ellensen Marit Farstad Eivind Strandenes Rajinder Sharma Marianne Øksnes Anders Kjellevold Storesund Solveig Moss Kolseth Multi-disciplinary treatment of broncho-esophageal fistula in a high-risk single-lung patient Journal of Cardiothoracic Surgery Bronchial stent Broncho-esophageal fistula Bronchoplasty Esophagectomy Esophageal stent Non-small lung cancer |
| title | Multi-disciplinary treatment of broncho-esophageal fistula in a high-risk single-lung patient |
| title_full | Multi-disciplinary treatment of broncho-esophageal fistula in a high-risk single-lung patient |
| title_fullStr | Multi-disciplinary treatment of broncho-esophageal fistula in a high-risk single-lung patient |
| title_full_unstemmed | Multi-disciplinary treatment of broncho-esophageal fistula in a high-risk single-lung patient |
| title_short | Multi-disciplinary treatment of broncho-esophageal fistula in a high-risk single-lung patient |
| title_sort | multi disciplinary treatment of broncho esophageal fistula in a high risk single lung patient |
| topic | Bronchial stent Broncho-esophageal fistula Bronchoplasty Esophagectomy Esophageal stent Non-small lung cancer |
| url | https://doi.org/10.1186/s13019-024-03287-5 |
| work_keys_str_mv | AT runehaaverstad multidisciplinarytreatmentofbronchoesophagealfistulainahighrisksinglelungpatient AT kjellovrebo multidisciplinarytreatmentofbronchoesophagealfistulainahighrisksinglelungpatient AT lorentzsandvik multidisciplinarytreatmentofbronchoesophagealfistulainahighrisksinglelungpatient AT havardseland multidisciplinarytreatmentofbronchoesophagealfistulainahighrisksinglelungpatient AT gunnarrekstenhusebø multidisciplinarytreatmentofbronchoesophagealfistulainahighrisksinglelungpatient AT vegardskalstadellensen multidisciplinarytreatmentofbronchoesophagealfistulainahighrisksinglelungpatient AT maritfarstad multidisciplinarytreatmentofbronchoesophagealfistulainahighrisksinglelungpatient AT eivindstrandenes multidisciplinarytreatmentofbronchoesophagealfistulainahighrisksinglelungpatient AT rajindersharma multidisciplinarytreatmentofbronchoesophagealfistulainahighrisksinglelungpatient AT marianneøksnes multidisciplinarytreatmentofbronchoesophagealfistulainahighrisksinglelungpatient AT anderskjellevoldstoresund multidisciplinarytreatmentofbronchoesophagealfistulainahighrisksinglelungpatient AT solveigmosskolseth multidisciplinarytreatmentofbronchoesophagealfistulainahighrisksinglelungpatient |