Thoracoscopic esophageal drainage for tracheal compression due to mucocele after esophagogastric bypass: a case report
Abstract Background Esophagogastric bypass is performed for esophageal strictures. Mucus retention, known as mucocele, sometimes occurs at the stricture oral side of the remnant esophagus. It is often asymptomatic and is expected to be naturally decompressed, but it may cause respiratory failure dep...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2023-06-01
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| Series: | Surgical Case Reports |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40792-023-01693-w |
| _version_ | 1797801216690880512 |
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| author | Takeshi Yamashita Koji Otsuka Satoru Goto Tomotake Ariyoshi Kentaro Motegi Masahiro Kohmoto Akira Saito Koichiro Fujimasa Yoshihito Sato Rei Kato Tetsuo Sawatani Masahiko Murakami |
| author_facet | Takeshi Yamashita Koji Otsuka Satoru Goto Tomotake Ariyoshi Kentaro Motegi Masahiro Kohmoto Akira Saito Koichiro Fujimasa Yoshihito Sato Rei Kato Tetsuo Sawatani Masahiko Murakami |
| author_sort | Takeshi Yamashita |
| collection | DOAJ |
| description | Abstract Background Esophagogastric bypass is performed for esophageal strictures. Mucus retention, known as mucocele, sometimes occurs at the stricture oral side of the remnant esophagus. It is often asymptomatic and is expected to be naturally decompressed, but it may cause respiratory failure depending on the case. Herein, we report a case in which we successfully performed thoracoscopic esophageal drainage as emergency airway management due to tracheal compression by a mucocele after esophagogastric bypass for unresectable esophageal cancer with esophagobronchial fistula. Case presentation A 56-year-old man underwent esophageal bypass surgery for an unresectable esophageal carcinoma with an esophagobronchial fistula following chemotherapy and radiation therapy. Nine months after bypass surgery, he experienced severe dyspnea due to tracheal compression caused by mucus retention on the oral side of the esophageal tumor. We planned thoracoscopic surgery for mucus retention drainage through the right thoracic cavity to secure the airway as an emergency procedure under general anesthesia. Intubation can be performed safely by guiding bronchoscopy in the semi-supine position. Upper esophageal dilation was observed on the cranial side of the azygos arch. We dissected the mediastinal pleura of the upper thoracic esophagus and exposed its wall. A 12-Fr silicone drain was placed in the esophagus through the right chest wall and 120 ml of white fluid was aspirated. He was discharged 9 days after surgery without complications and resumed treatment with an immune checkpoint inhibitor 23 days after surgery. Thereafter, he continued chemotherapy for esophageal cancer, but died of tumor progression and lung metastasis 35 months after bypass surgery and 25 months after thoracoscopic surgery. Conclusions Thoracoscopic esophageal drainage could be performed safely as emergency airway management, shorten the period of discontinuance, and allow cancer treatment to be resumed promptly. We believe that this thoracoscopic procedure is an effective and less invasive method if the percutaneous approach is difficult. |
| first_indexed | 2024-03-13T04:47:05Z |
| format | Article |
| id | doaj.art-04c52ac577c2475ca212a434c299f1c7 |
| institution | Directory Open Access Journal |
| issn | 2198-7793 |
| language | English |
| last_indexed | 2024-03-13T04:47:05Z |
| publishDate | 2023-06-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Surgical Case Reports |
| spelling | doaj.art-04c52ac577c2475ca212a434c299f1c72023-06-18T11:23:32ZengSpringerOpenSurgical Case Reports2198-77932023-06-01911510.1186/s40792-023-01693-wThoracoscopic esophageal drainage for tracheal compression due to mucocele after esophagogastric bypass: a case reportTakeshi Yamashita0Koji Otsuka1Satoru Goto2Tomotake Ariyoshi3Kentaro Motegi4Masahiro Kohmoto5Akira Saito6Koichiro Fujimasa7Yoshihito Sato8Rei Kato9Tetsuo Sawatani10Masahiko Murakami11Esophageal Cancer Center, Showa University HospitalEsophageal Cancer Center, Showa University HospitalEsophageal Cancer Center, Showa University HospitalEsophageal Cancer Center, Showa University HospitalEsophageal Cancer Center, Showa University HospitalEsophageal Cancer Center, Showa University HospitalEsophageal Cancer Center, Showa University HospitalEsophageal Cancer Center, Showa University HospitalEsophageal Cancer Center, Showa University HospitalEsophageal Cancer Center, Showa University HospitalEsophageal Cancer Center, Showa University HospitalEsophageal Cancer Center, Showa University HospitalAbstract Background Esophagogastric bypass is performed for esophageal strictures. Mucus retention, known as mucocele, sometimes occurs at the stricture oral side of the remnant esophagus. It is often asymptomatic and is expected to be naturally decompressed, but it may cause respiratory failure depending on the case. Herein, we report a case in which we successfully performed thoracoscopic esophageal drainage as emergency airway management due to tracheal compression by a mucocele after esophagogastric bypass for unresectable esophageal cancer with esophagobronchial fistula. Case presentation A 56-year-old man underwent esophageal bypass surgery for an unresectable esophageal carcinoma with an esophagobronchial fistula following chemotherapy and radiation therapy. Nine months after bypass surgery, he experienced severe dyspnea due to tracheal compression caused by mucus retention on the oral side of the esophageal tumor. We planned thoracoscopic surgery for mucus retention drainage through the right thoracic cavity to secure the airway as an emergency procedure under general anesthesia. Intubation can be performed safely by guiding bronchoscopy in the semi-supine position. Upper esophageal dilation was observed on the cranial side of the azygos arch. We dissected the mediastinal pleura of the upper thoracic esophagus and exposed its wall. A 12-Fr silicone drain was placed in the esophagus through the right chest wall and 120 ml of white fluid was aspirated. He was discharged 9 days after surgery without complications and resumed treatment with an immune checkpoint inhibitor 23 days after surgery. Thereafter, he continued chemotherapy for esophageal cancer, but died of tumor progression and lung metastasis 35 months after bypass surgery and 25 months after thoracoscopic surgery. Conclusions Thoracoscopic esophageal drainage could be performed safely as emergency airway management, shorten the period of discontinuance, and allow cancer treatment to be resumed promptly. We believe that this thoracoscopic procedure is an effective and less invasive method if the percutaneous approach is difficult.https://doi.org/10.1186/s40792-023-01693-wBypass surgeryEsophageal cancerThoracoscopic drainage |
| spellingShingle | Takeshi Yamashita Koji Otsuka Satoru Goto Tomotake Ariyoshi Kentaro Motegi Masahiro Kohmoto Akira Saito Koichiro Fujimasa Yoshihito Sato Rei Kato Tetsuo Sawatani Masahiko Murakami Thoracoscopic esophageal drainage for tracheal compression due to mucocele after esophagogastric bypass: a case report Surgical Case Reports Bypass surgery Esophageal cancer Thoracoscopic drainage |
| title | Thoracoscopic esophageal drainage for tracheal compression due to mucocele after esophagogastric bypass: a case report |
| title_full | Thoracoscopic esophageal drainage for tracheal compression due to mucocele after esophagogastric bypass: a case report |
| title_fullStr | Thoracoscopic esophageal drainage for tracheal compression due to mucocele after esophagogastric bypass: a case report |
| title_full_unstemmed | Thoracoscopic esophageal drainage for tracheal compression due to mucocele after esophagogastric bypass: a case report |
| title_short | Thoracoscopic esophageal drainage for tracheal compression due to mucocele after esophagogastric bypass: a case report |
| title_sort | thoracoscopic esophageal drainage for tracheal compression due to mucocele after esophagogastric bypass a case report |
| topic | Bypass surgery Esophageal cancer Thoracoscopic drainage |
| url | https://doi.org/10.1186/s40792-023-01693-w |
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