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Airway Obstruction Caused by Loculated Mediastinal Effusion after Ivor Lewis Operation

  • Kim, Hyun Jo (Department of Cardiothoracic Surgery, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine)
  • Received : 2014.01.21
  • Accepted : 2014.03.18
  • Published : 2014.06.05

Abstract

Airway obstruction after esophageal surgery is quite rare, and few such cases have been reported. A 57-year-old woman who underwent the Ivor Lewis procedure for esophageal carcinoma complained of a sudden onset of severe dyspnea on postoperative day 3. Chest computed tomography scan revealed that the collection of a large volume of mediastinal fluid caused marked luminal compression on the trachea and the gastric conduit. Explorative thoracotomy revealed a clear serous fluid in the space between the trachea and the gastric conduit, and all respiratory symptoms were relieved after the fluid was drained. The possibility of tracheal compression by loculated effusion, such as chyloma, should be considered in a patient who complains of respiratory deterioration after esophageal surgery.

Keywords

References

  1. Bechard P, Letourneau L, Lacasse Y, Cote D, Bussieres JS. Perioperative cardiorespiratory complications in adults with mediastinal mass: incidence and risk factors. Anesthesiology 2004;100:826-34. https://doi.org/10.1097/00000542-200404000-00012
  2. Funakoshi Y, Takeda S, Kadota Y, Maeda H. Mediastinal bronchogenic cyst with respiratory distress from airway and vascular compression. Thorac Cardiovasc Surg 2007;55:53-4.
  3. Kim S, Gotway MB, Webb WR, Gordon RL, Golden JA. Tracheal compression by the stomach following gastric pull-up: diagnosis with CT and treatment with expandable metallic stent placement. Chest 2002;121:998-1001. https://doi.org/10.1378/chest.121.3.998
  4. Miller KB, Kaplan B, Shepherd RW. Severe tracheal compression causing respiratory failure after transhiatal esophagectomy. Ann Thorac Surg 2010;89:977-9. https://doi.org/10.1016/j.athoracsur.2009.05.088
  5. Ikeda N, Akutsu Y, Shuto K, Tohma T, Matsubara H. Tracheal compression by the gastric tube in esophageal cancer with ankylosing spondylitis and an analysis of the mediastinal condition in 84 cases of esophagectomy: report a case. Surg Today 2013;43:1071-4. https://doi.org/10.1007/s00595-012-0275-9
  6. Cho S, Kim JW, Lee H, Lee EB. Intramural hematoma of gastric tube after Ivor Lewis operation. Ann Thorac Surg 2010;89:2016-7. https://doi.org/10.1016/j.athoracsur.2009.10.071
  7. Francis S, Russell WC, Thompson JP. Complete airway obstruction in a ventilated patient after oesophageal dilatation. Br J Anaesth 2002;89:517-9. https://doi.org/10.1093/bja/89.3.517
  8. Pera M, Belda J, Vidal O, Rubio M, Grande L. Mediastinal chyloma after esophageal cancer resection: an unusual complication causing left cardiac failure. J Thorac Cardiovasc Surg 2002;124:198-9. https://doi.org/10.1067/mtc.2002.122968
  9. Rottoli M, Russo IS, Bernardi D, Bonavina L. Atypical presentation and transabdominal treatment of chylothorax complicating esophagectomy for cancer. J Cardiothorac Surg 2012;7:9. https://doi.org/10.1186/1749-8090-7-9