Cases reported "Esophageal Stenosis"

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1/18. Colon-patch oesophagoplasty.

    Colon-patch oesophagoplasty has been tried experimentally and used clinically to treat benign strictures of the oesophagus in children. However, reports are few. We advocate this operation and report on two cases where this technique was employed for caustic stricture using a vascularized colon patch avoiding the need for oesophageal substitution. This procedure has its immediate and late complications but after a long follow-up we are satisfied with our results. Patching is a useful alternative to substitution for limited benign strictures of oesophagus in children.
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2/18. Redoing reconstruction of the esophagus using remnants of the ileo-left colon aided by microvascular anastomosis.

    Theoretically, the jejunum, fasciocutaneous or myocutaneous flap is recommended as an esophageal substitute in redoing reconstruction of the esophagus after a second incidence of corrosive injury. However, other esophageal substitutes should also be considered. We present a case of a 42-year-old woman who underwent esophageal reconstruction using an ileocolon graft for corrosive esophageal stricture ten years before. The patient ingested caustic drain cleaner again and underwent resection of the ileocolon graft secondary to corrosive necrosis. Two and a half months after the second incidence of corrosive injury, reconstruction of the esophagus was again performed using a graft of remnant ileo-left colon aided by microvascular anastomosis. The patient was able to swallow a regular diet after the procedure. Remnant ileo-left colon is a good alternative esophageal substitute in cases of repeated corrosive injury.
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3/18. Complication of esophageal self-dilation for radiation-induced hypopharyngeal stenosis.

    We present an unusual case of hypopharyngeal stenosis, secondary to radiation therapy for laryngeal squamous cell carcinoma, complicated by repeated inadvertent passage of a Maloney dilator through the larynx into the right mainstem bronchus during self-dilation. A brief review of esophageal/hypopharyngeal stenosis and management alternatives is presented. Self-dilation is presented as a therapeutic method for recurrent stenosis of the hypopharynx and esophagus. Recognition and avoidance of this complication is discussed.
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4/18. Treatment of a radiation-induced esophageal web with retrograde esophagoscopy and puncture.

    OBJECTIVE: To present a technique for the treatment of complete esophageal stenosis in the post-radiation patient that may be applied to selected patients with obstructing stenoses. STUDY DESIGN: A case report of the treatment of a post-radiation esophageal web. methods: A review of the patient's history of treatment and a discussion of reported treatment options. RESULTS: A complete obstruction of the cervical esophagus was diagnosed in a patient after chemoradiation for a hypopharyngeal carcinoma. Retrograde esophagoscopy through the patient's percutaneous endoscopic gastrostomy tube site aided visualization and perforation of the obstructing tissue. Subsequent dilation has allowed the patient to resume oral intake of a regular diet without restrictions. CONCLUSION: Combined direct laryngoscopy with retrograde esophagoscopy represents a viable alternative to more extensive approaches for recannulization of selected obstructing esophageal stenoses.
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5/18. Treatment of colon conduit redundancy in a child with esophageal atresia.

    We recently revised a redundant colon conduit in a boy who was born with isolated esophageal atresia. In view of the paucity of reports dealing with correction of this common complication of esophageal replacement, it seemed appropriate to report our experience. Because of effective medical therapy of acid peptic disease, patients who formerly required conduit replacement may now be candidates for revision; however, the medical literature does not specify when conduit revision, as opposed to conduit replacement, is indicated; also, no guidance is provided regarding what constitutes effective operative revision. Innovative techniques that stretch and elongate the atretic esophagus will likely lessen the use of conduits in esophageal atresia; nevertheless, colon conduits are useful in many other clinical situations and will remain an essential part of the armamentarium of pediatric, general, and thoracic surgeons. This report highlights the DeMeester and Tannuri technique, whereby a colon conduit is prepared like a Roux limb. The mesentery is divided only once; the conduit's blood supply is not severed from the distal mesocolon. This innovation improves a conduit's blood supply and lessens its attendant complications. Lastly, we describe a muscle splitting, posterolateral thoracotomy technique that is simpler than the alternatives and is useful in a variety of clinical situations.
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6/18. Recurrent benign esophageal strictures treated with self-bougienage: report of seven cases.

    Self-bougienage has rarely been used in the treatment of recurrent benign esophageal strictures. Nonetheless, it has proved to be a useful alternative technique in carefully selected patients. Herein we report our experience with seven symptomatic patients who were treated with self-bougienage for recurrent benign esophageal strictures. These seven patients (six men and one woman; mean age, 66.9 years) had had dysphagia for a mean of 37.9 months and had undergone a mean of 6.7 endoscopic dilations before their involvement in a self-bougienage program. During a mean follow-up period of 36.3 months (range, 10 to 78 months) after initiation of self-bougienage treatment, all seven patients became asymptomatic and remained free of dysphagia. No complications occurred in any patient, and no further endoscopic dilations were necessary. Our results suggest that self-bougienage can provide long-term symptomatic relief in selected patients with recurrent benign esophageal strictures.
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7/18. Balloon dilatation of upper gastrointestinal tract strictures.

    Balloon dilatation has been performed in a series of 30 patients with strictures of the upper gastrointestinal tract over a period of 28 months. The technique of balloon dilatation is described and the results of follow-up are presented. Sixty per cent of patients have remained symptom-free following balloon dilatation. Twenty-seven per cent of patients have undergone regular repeated dilatations when symptoms have recurred. There were no complications from the technique. Balloon dilatation is a safe and acceptable alternative to conventional methods of bougienage in the management of upper gastrointestinal tract strictures.
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8/18. Dysphagia lusoria: proposal of a new treatment.

    Recent observation of one patient suffering from dysphagia lusoria has suggested critical review of treatment of the symptomatic aberrant right subclavian artery. Surgical correction of such an anomaly is difficult and may produce serious complications, and is not always successful. Endoscopic dilatation of the oesophageal stricture, even though it might only produce temporary relief of dysphagia, represents a valid therapeutical alternative because of its favourable cost/benefit ratio, low incidence of complications and patient acceptability.
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9/18. Hydrostatic balloon catheters. A new dimension of therapeutic endoscopy.

    Disorders secondary to strictures of various segments of the gastrointestinal tract, e.g. esophagus, stomach, bile ducts, pancreas and colon often produce symptoms requiring continuing medical management or aggressive intervention. Until now, surgery has been required for failures of medical treatment. Endoscopically placed balloon catheters offer an alternative method for effectively treating a variety of gastrointestinal strictures. In this report we present examples of applications of balloon catheters in clinical gastroenterology.
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10/18. Intrathoracic fundoplication for shortened esophagus. Treacherous solution to a challenging problem.

    Intrathoracic fundoplication was used in 12 patients with acquired shortening of the esophagus secondary to gastroesophageal reflux. While several patients had excellent results using this approach, five major complications occurred. One patient developed a paraesophageal hernia, while four had ulceration within the wrap itself. One had serious hemorrhage, while another required reoperation to dismantle the intrathoracic wrap. One patient developed a gastrobronchial fistula and eventually died from pulmonary sepsis. The cause of these problems is unknown, but delayed gastric emptying was implicated in two patients. Even though leaving a Nissen fundoplication in the chest seems to be an attractive alternative when the surgeon cannot reduce the wrap below the diaphragm, this alternative is fraught with treacherous complications in a large percentage of patients.
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