1/66. tracheoesophageal fistula caused by a self-expanding esophageal stent.A patient is presented who had previously undergone an esophagectomy for an adenocarcinoma of distal esophagus. He experienced repeated strictures at the esophagogastric anastomosis at 22 cm. After multiple dilatations, a self-expanding metal stent was placed. Four months later the upper edge of the stent eroded through the esophagus into the trachea, forming a tracheoesophageal fistula. Muscle flap repair was successful.- - - - - - - - - - ranking = 1keywords = carcinoma (Clic here for more details about this article) |
2/66. Esophageal carcinoma showing a long stricture due to prominent lymphatic permeation: report of a case.Some esophageal diseases such as carcinoma, esophagitis, and collagen diseases have often been reported to show a diffusely thickened esophageal wall in the roentogenogram findings. In the current report, a preoperative upper gastrointestinal series and an endoscopic examination showed a diffusely infiltrative type carcinoma, but other examinations did not suggest any diseases such as esophagitis or collagen diseases which might cause a thickening of the esophageal wall or a constriction of the esophagus. A postoperative histological examination revealed the primary carcinoma to remain only within the mucosal layer, while a large degree of lymphatic vessel permeation reached the adventitia over a wide area. An extraordinary degree of lymphatic permeation spread through the esophageal wall, and stromal fibrosis developed as a result of such lymphatic permeation. These histological phenomena might thus have led to the macroscopic appearance of infiltrative type esophageal carcinoma.- - - - - - - - - - ranking = 8keywords = carcinoma (Clic here for more details about this article) |
3/66. Severe complications caused by dissolution of latex with consequent self-disintegration of esophageal plastic tubes.A case of decisive material degeneration of an esophageal Celestin tube is described: a 50-year-old man with adenocarcinoma of the distal esophagus received a Celestin tube for palliative endoscopic treatment and 8 months later presented with suddenly occurring complete dysphagia. Dissolution of the latex layer in the proximal as well as the distal part of the tube had caused self-disintegration of the Celestin tube and had liberated the monofilament nylon coil which completely obstructed the lumen of the tube. Endoscopic tube removal was only possible by careful attachment of a balloon catheter and peroral extraction after insufflation with contrast medium up to 5 atm. A medline-based review of the literature revealed different but predominantly severe complications (perforation, hemorrhage, obstruction, and peritonitis) based on material fatigue of the latex layer in esophageal Celestin tubes. At least 6 months after placement of a Celestin tube, regular fluoroscopic controls should be performed to detect early disintegration of the tube. Indication for the placement of Celestin tubes in patients with benign esophageal strictures and longer life expectancy should be assessed very critically.- - - - - - - - - - ranking = 1keywords = carcinoma (Clic here for more details about this article) |
4/66. Fatal intestinal perforation secondary to fragmentation of a Celestin tube.BACKGROUND/AIMS: Oesophageal intubation remains one of the principal methods of palliation for an obstructing oesophageal carcinoma. We present a case which illustrates a rare but fatal complication of this procedure. methods: A 60-year-old female with oesophageal cancer presented with total dysphagia 9 months following insertion of a Celestin tube for palliation. Oesophagoscopy revealed a bolus obstruction which was successfully cleared. Two days later she developed generalised peritonitis and subsequently died. RESULTS: A post-mortem examination demonstrated fragmentation and displacement of the distal part of the Celestin tube resulting in perforation of the small bowel. CONCLUSION: Celestin tube disintegration is a risk associated with long-term use, and routine replacement is indicated in patients with a prolonged survival to avoid this complication.- - - - - - - - - - ranking = 1keywords = carcinoma (Clic here for more details about this article) |
5/66. Endoscopic retrieval of a broken and migrated esophageal metal stent.In patients with inoperable malignant tumors of the esophagus or cardia, self-expanding metal stents are increasingly used to improve dysphagia. Usually, they are not difficult to place and, as compared to conventional plastic stents, complications such as stent migration or perforation, seem to occur less frequently. This is a report on a young patient with metastatic adenocarcinoma of the cardia, who was treated with a self expanding metal stent after endoscopic dilatation of a tumor stenosis in the distal esophagus. Immediately after the procedure, he was able to eat and gained weight. Within 6 weeks and while on continuous infusion of 5-fluorouracil, the patient complained about recurrent severe dysphagia. Plain x-ray demonstrated a broken and migrated stent, the 2 parts of which were seen in the stomach and the duodenum. The stent could be extracted endoscopically without any complication, but the procedure was difficult and lasted 4 h, as the stent broke 2 more times during retrieval.- - - - - - - - - - ranking = 1keywords = carcinoma (Clic here for more details about this article) |
6/66. Treatment of post-stent gastroesophageal reflux by anti-reflux Z-stent.Severe symptoms of heartburn and retrosternal pain consistent with gastro-esophageal reflux (GER) developed in a patient following placement of a conventional self-expanding 16-24-mm-diameter x 12-cm-long esophageal stent across the gastroesophageal junction to treat an obstructing esophageal carcinoma. A second 18-mm-diameter x 10-cm-long esophageal stent with anti-reflux valve was deployed coaxially and reduced symptomatic GER immediately. Improvement was sustained at 4-month follow-up. An anti-reflux stent can be successfully used to treat significant symptomatic GER after conventional stenting.- - - - - - - - - - ranking = 1keywords = carcinoma (Clic here for more details about this article) |
7/66. Esophageal hypermotility associated with intramural pseudodiverticulosis. Primary esophageal disease or epiphenomena?Esophageal intramural pseudodiverticulosis is a very rare disease of unclear etiology. The clinical picture is characterized by progressive dysphagia. Because of its frequent association with alcohol abuse and subsequent weight loss, it must be differentiated reliably from esophageal carcinoma. The diagnosis is established by the characteristic detection of multiple intramural contrast accumulations in the barium esophagogram. Additional endoscopic and endosonographic confirmation and histological examination are required to exclude a malignant tumor. Moreover, associated diseases are almost always present and should also be diagnosed by pH-metry, cytology, and esophageal manometry. Good and long-lasting therapeutic success can be achieved by bouginage of the stenosis with concomitant treatment of the associated esophageal diseases. Based on two case reports of patients with this disease, we discuss the unusual association with esophageal hypermotility as well as the symptoms, clinical course, therapy, and pathogenesis of the disease.- - - - - - - - - - ranking = 1keywords = carcinoma (Clic here for more details about this article) |
8/66. Treatment of a malignant stenosis of the corpus of the stomach with a self-expanding stent.In a 50-year-old man, a self-expandable stent was implanted under fluoroscopic guidance to treat symptoms of an inoperable carcinoma of the corpus of the stomach. Foreshortening of the stent necessitated implantation of a proximal extension stent 5 weeks later. Secondary symptoms of advanced stage of the disease negatively influenced clinical success of the procedure, although free passage through the stents was achieved. We conclude that stent implantation for palliation of a carcinoma of the corpus of the stomach seems to be a viable method. The operator has to be aware of the special limitations and problems associated with the procedure.- - - - - - - - - - ranking = 2keywords = carcinoma (Clic here for more details about this article) |
9/66. Self-expandable metallic stent therapy of esophagojejunal stricture in a stapled anastomosis: a case report and review of the literature.The introduction of the stapler apparatus has provided safe and effective gastrointestinal anastomotic surgical operations for most surgeons. However, the major disadvantage of stapler surgery is an increased risk of anastomotic stricture formation. Treatment of this kind of stricture is performed mainly by using endoscopic balloon dilators. However, this therapy may fail or the patient may become reactive or uncooperative during dilatation sessions. Herein, we present a case to show the successful and uncomplicated insertion of a self-expanding metallic stent into an esophagojejunal anastomotic stricture which developed 1 month after total gastrectomy and stapled esophagojejunal anastomosis in a patient with gastric carcinoma. This is the 3rd report in the literature.- - - - - - - - - - ranking = 1keywords = carcinoma (Clic here for more details about this article) |
10/66. adenocarcinoma in a Barrett oesophagus.A case of adenocarcinoma developing at the squamocolumnar epithelial junction of a Barrett oesophagus is reported. This rare tumour was remarkable because of the youth of the patient and because of the signet-cell cytological pattern of the neoplasm. It is postulated that both the columnar epithelial lining of the lower part of the oesophagus and the malignant change are a consequence of long-standing oesophageal reflux.- - - - - - - - - - ranking = 5keywords = carcinoma (Clic here for more details about this article) |
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