bluuebunny/crossref_metadata_2025_split huggingface dataset:
PS01.090: LAPAROSCOPIC EXCISION OF A PARAESOPHAGEAL BRONCHOGENIC CYST IN A 9-YEAR-OLD MALE
Authors: Makita Satoshi 
Published: September 2018

Abstract

Background
Bronchogenic cyst is a malformation of the ventral foregut. It is ofen asymptomatic and discovered as an incidental finding. In children, it comprises approximately 6% of all mediastinal masses. However, paraesophageal bronchogenic cyst is a rare and has been reported only three cases in children. We report a case of a 9-year-old male with an asymptomatic paraesophageal bronchogenic cyst.

Methods
Retrospective chart review.

Results
A 9-year-old male was detected to have retrocardiac mass lesion (2.7 × 1.9 × 1.2 cm), which was detected incidentally on an abdominal computed tomography done for acute appendicitis. No enhancement was noticed after contrast administration. Magnetic resonance imaging revealed a well-circumscribed cyst adjacent to the esophagus just above the hiatus. T1-weighted image showed a low intensity mass and the T2-weighted image showed a high intensity mass. Endoscopic ultrasonography examination of the esophagus demonstrated a cystic mass, with low-echo density. The echo also showed disruption of the fourth layer of the esophageal wall. With these findings, esophageal duplication was suspected. A laparoscopic operation was performed via 4 ports plus one puncture. 5mm laparoscope (30°angle) was inserted in the umbilical port, three 5mm trocars were placed and 3mm grasping forceps was inserted. The cyst was identified in the intra-abdominal esophageal part. Lesion removal was performed with a coagulator hook. A complete excision of the cyst was achieved without perforating of the esophagus. The postoperative courses was uneventful with home discharging on day six. The pathological diagnosis was a bronchogenic cyst because of finding a ciliated respiratory epithelium and cartilage and mucus-secreting glands.

Conclusion
Paraesophageal bronchogenic cyst is rare. However, it should be considered in the differential diagnoses for mediastinal masses at any age. Laparoscopy is a safe and effective method to deal with masses of posterior mediastinum even in children.

Disclosure
All authors have declared no conflicts of interest.
PS01.091: A DANGEROUS FOREIGN BODY IN ESOPHAGUS: ALKALINE BATTERIES
Authors: Aydin Yener , Eroglu Atila , Turkyilmaz Atila , Genc Fatma , Ulas Ali 
Published: September 2018

Abstract

Background
Esophageal foreign bodies are an important clinical condition leading to serious morbidity and mortality. Foreign body swallowing is most common in the group of 6 months to 6 years. Although smooth edges have a lower morbidity in foreign bodies, alkaline batteries are very dangerous. In this study, we aimed to evaluate the results of patients who ingested alkaline batteries.

Methods
We conducted a retrospective single-center study of 20 patients who were diagnosed with esophageal foreign objects following alkaline battery ingestion between January 2001 and February 2018. All cases were evaluated with posteroanterior chest X-ray and lateral X-ray. Age and sex of the patients, symptoms, localization of foreign body, the method of removing the foreign body, the passing time, length of hospital stay and morbidity and mortality rates were reviewed.

Results
The cases were 12 males and 8 females. The mean age was 3.2 years (1 month to 14 years). Five cases within 4 hours, 8 cases within 12 hours, 5 cases within 24 hours and 2 cases after 24 hours were referred to our clinic. The foreign body was located in the cervical esophagus in 10 cases, in the midthoracic esophagus in 8 cases, and in distal esophagus in two cases. All cases were quickly taken to the operating room. All cases underwent rigid esophagoscopy under general anesthesia and foreign body was removed. Sixteen cases of esophageal mucosal injury and burns were seen. Perforation and mortality were not observed in any of the cases.

Conclusion
Severe esophageal injury can occur in a short time after interaction with alkaline battery. Alkaline battery; electrolyte leak, pressure necrosis, mercury toxicity, or alkaline environment. Concentrated potassium hydroxide release has a corrosive effect. In this case, mediastinitis or tracheoesophageal fistula may ocur. Alkaline battery ingestion may result in persistent sequelae with perforation and corrosive esophagitis leading to mediastinitis. For this reason, the battery should be immediately removed by rigid esophagoscopy to prevent the development of these complications.

Disclosure
All authors have declared no conflicts of interest.
PS01.096: CHOOSING THE TREATMENT OPTION OF END-STAGE CARDIAC ACHALASIA
Authors: Koshkin Mikhail , Vasnev Oleg , Baychorov Magomet , Izrailov Roman , Shishin Kirill , Domrachev Sergey , Kazakova Svetlana 
Published: September 2018

Abstract

Background
Until recently the esophagectomy was the only choice in treatment of patients with end-stage achalasia. Developing of minimally invasive techniques such as a laparoscopic Heller miotomy and peroral endoscopic myotomy (POEM) allowed to use them as a treatment options. Aim: to present an experience of treatment of patents with end-stage cardiac achalasia.

Methods
Since 07.2013 till the 12.2017 eleven patients with end-stage cardiac achalasia were operated on. Among them 2 (18%) were males and 9 (82%) were females. Mean age was 54 years (26–81).

Results
POEM was performed in 6 patients, laparoscopic Heller myotomy was performed in 2, and esophagectomies were performed in 3 patients with failed previously myotomy made in other clinics. Gastric tube was used to replace the esophagus in patients underwent esophagectomy. Mean operative time was 90 min for POEM, 172 minutes for laparoscopic Heller procedure and 422 minutes for laparoscopic esophagectomy. Blood loss was insignificant in all patients. There were no clinically significant complications during the postoperative course of all patients. Mean postoperative hospital stay was 2 days after POEM, 4 days after laparoscopic Heller procedure and 11 days after esophagectomy. To asses the dysphagia after POEM and Heller procedure Eckardt scale was used. In all cases it was rated as grade 0.

Conclusion
Minimally invasive techniques such as POEM and laparoscopic Heller procedure should be the first options in surgical treatment of patients with end-stage cardiac achalasia. In case of ineffectiveness of these options esophagectomy should be performed.

Disclosure
All authors have declared no conflicts of interest.
PS01.101: SURGICAL MANAGEMENT OF ADULT ESOPHAGO-RESPIRATORY FISTULA: A TEN-YEAR EXPERIENCE.
Authors: Samarasam Inian , Phillip Rajeevan , Gnanamuthu Roy , Abraham Vijay 
Published: September 2018

Abstract

Background
Adult esophago-respiratory fistula is a rare condition, which is usually seen in malignancies or in benign conditions following trauma, infection or as a delayed presentation of congenitall tracheoesophageal fistula. They pose a technical challenge in stabilisation and management requiring multidisciplinary approach.

Methods
In this retrospective analysis of such cases over a period of ten years, who presented to our centre. The aetiology, presentation and treatment modalities were studied in detail. Of these,18 patients with benign esophago repiratory fistulae underwent surgical correction oft he same. This is discussed in detail.

Results
There were a total of 62 cases of adult esophago-respiratory fistula, over the 10 year period. Of the patients, 34 of the cases to be of malignant etiology and 28 of the cases to be of benign etiology such as prolonged tracheostomy, corrosive injury, infection, trauma or delayed presentation of congenital fistula. The mean age of presentation was 44 years. (range 18 to 81 years of age). There were 35 tracheoesophageal fistulae and 27 bronchoesophageal fistulae. Fourteen patients underwent esophageal stenting and 9 underwent tracheal stenting either as a temporary intervention to alleviate symptoms or as palliative intervention. Eighteen patients underwent definitive surgical intervention. Surgical repair involved approach through neck in 6 patients and thorax in 11 patients and a combination of both approaches in one patient. The esophageal end of the fistula was primarily closed or closed with the help of a pleural or pedicled muscle flap or a subtotal esophagectomy was performed. The respiratory end of the fistula was either primarily closed or with the help of a vascularized patch of the esophageal wall. The latter technique was used in four patients and is explained in detail.

Conclusion
Due to risk of fatal complications, early diagnosis, multidisciplinary approach and appropriate surgical intervention after nutritional build up is the key to successful management of adult esophago-respiratory fistula.

Disclosure
All authors have declared no conflicts of interest.
PS01.103: THE UNUSUAL CAUSES OF ODYNOPHAGIA
Authors: Tian Lim Kheng 
Published: September 2018

Abstract

Background
Odynophagia can be caused by infective and non-infective inflammatory processes, benign and malignant esophageal disorders such as achalasia, gastro-esophageal reflux disease and carcinoma.

Methods
We described two unusual cases of odynophagia and their individual management.

Results
Case 1 is a 21 year-old Indian man presented with 2 days history of odynophagia after taking doxycycline capsules indicated for acne. An esophagogastroduodenoscopy (OGD) was performed and showed multiple mid esophageal ulcers. Esophageal biopsy taken showed inflammatory ulcer slough with no fungal infection, dysplasia or malignancy. Doxycycline was stopped and patient recovered with complete resolution of odynophagia. Case 2 is a 55 year-old Chinese man presented with 1 day history of odynophagia and severe chest pain after eating a bowl of hot fish soup. A CT Thorax was performed which showed a localised perforation of the right wall of the esophagus with extraluminal gas posterior to the trachea. An urgent OGD was performed and an L-shaped fish bone was removed successfully and an endoclip was applied to close the puncture hole of esophagus. Patient made a full recovery without any mediastinal infection.

Conclusion
Odynophagia from mid esophageal ulcers secondary to doxycycline intake should be recognized and can be easily managed by stopping the antibiotics with complete resolution of the symptom. Fish ingestion leading to sharp bone induced penetrating esophageal injury can be safely managed by endoscopic removal and endoclip application.

Disclosure
All authors have declared no conflicts of interest.
PS01.105: PANCREATITIS IN THE ESOPHAGEAL ECTOPIC PANCREAS: A RARE CONDITION WITH DIFFERENT PRESENTATIONS! TREATMENTS AND REVIEW OF THE LITERATURE
Authors: Szachnowicz Sergio , Sallum Rubens , Libanori Hilton , Bianchi Edno , Duarte Andre , Stolzemburg Lucas , Cecconello Ivan 
Published: September 2018

Abstract

Background
Ectopic pancreas is an extremely rare genetic malformation in the esophagus. It is defined by pancreatic tissue outside the pancreas and usually presents as a subepithelial lesion in the esophagus. To date, there are fewer than 15 patients reported in the literature.

Methods
We present 2 cases of pancreatitis in the esophageal ectopic pancreas with different presentation, treatment and development, as well as a review of the literature.

Results
1. A 48-year-old woman admitted to the ER with acute dysphagia and chest pain. There were elevation of amylasemia and lipasemia, as well as presence of a tumor in the Gastroesophageal junction with hypersignal at the CT scan, suggesting acute inflammation. An echoendoscopy with biopsy, diagnosed ectopic pancreas in the distal esophagus. The patient was then submitted to laparoscopic resection of subepithelial tumor of the cardia, recovered by a fundoplication. The specimen confirmed pancreatic tissue with acute inflammation. 2. A 33-year-old woman with a history of episodic chest pain confused with GERD, nausea and vomiting pain episodes accompanied by elevated serum amylase and lipase levels. She was submitted to an ERCP without alterations to investigate the clinical complains. After some crisis she was hospitalized with a septic condition, where a CT scan revealed a cystic lesion in the lower mediastinum in the esophageal wall. Endoscopy was performed, showing a drainage orifice with purulent secretion in the cardia. She was treated with antibiotics and fasting. She had two more crises and was referred to our specialized service. Thoracoscopic subtotal esophagectomy with cervical anastomosis was performed for treatment of a suspected esophageal duplication cyst with recurrent infections. The specimen showed the presence of organized pancreatic tissue characterizing ectopic pancreas complicated with chronic pancreatitis.

Conclusion
The ectopic esophageal pancreas can be present as a differential of these lesions. The second case, was first admitted at a secondary care unit and the diagnosis was delayed, probably leading to a worse development and necessity of a esophagectomy. In the literature, there is only one description of 1 case of recurrent pancreatitis. We have shown that complications can range from dysphagia to abscess, requiring more invasive treatment.

Disclosure
All authors have declared no conflicts of interest.
PS01.110: ACUTE NECROTIZING ESOPHAGITIS WITH ESOPHAGUS PERFORATION, TREATED BY THORACOSCOPIC ESOPHAGECTOMY
Authors: Akaishi Ryujiro , Taniyama Yusuke , Sakurai Tadashi , Heishi Takahiro , Okamoto Hiroshi , Sato Chiaki , Takaya Kai , Maruyama Shota , Kamei Takashi 
Published: September 2018

Abstract

Background
Acute necrotizing esophagus is defined as the diffuse black pigmentation of the esophagus due to the necrosis of the esophageal mucosa, and so called ‘black esophagus’ from its endoscopic findings. The prevalence is only 0.001∼0.2%, although the mortality rate is up to 32%.

Methods
67 years old female with medical history of diabetes mellitus, transported to the emergency room with hematemesis and conscious disorder. She had suffered from nausea and epigastralgia for two days. Her general status was in shock vitals and didn’t respond to rehydration. After intubation, emergency endoscopic examination revealed black pigmentation of the esophageal mucosa and diagnosed as acute necrotizing esophagitis. Antibiotics and blood absorption therapy had been started and the patient gradually stabilized. 1 week after the admission, esophagus perforation was suspected from the significant increase of the right pleural effusion and free air at the esophagus wall and the mediastinum on CT scan. Emergency thoracoscopy was performed and found that the esophagus was edematous and adventitia was colored into black. The esophagectomy with esophagostomy and enterostomy was performed.

Results
On resected specimen, mucosal necrosis was found only on squamous epithelium with three perforating areas in the middle to lower thoracic esophagus. No signs of inflammation nor ischemia was found on the gastric mucosa of the esophagogastric junction. After the operation, patient recovered generally well, except the severe stenosis of the cervical esophagus had developed. Although endoscopic dilation had been constantly performed, the reconstruction remains unsolved issue.

Conclusion
In acute necrotizing esophagitis, stabilization of the patient's condition by treating comorbid diseases is extremely important. Improving the nutritional status in addition to the administration of antacids and antibiotics is also required. Surgical intervention should be performed when perforating mediastinitis or abscess formation occurs. Primary closure shouldn’t be attempted, and esophageal resection with delayed reconstruction should be considered in addition to drainage. In this case, we could successfully rescued the patient with necrotic esophagitis by performing surgical intervention promptly. It is important to detect the esophagus perforation and mediastinitis early, not to miss the chance of surgical intervention for curative treatment.

Disclosure
All authors have declared no conflicts of interest.
PS01.111: STAGED PEDICLED JEJUNAL TRANSFER AFTER AORTOESOPHAGECTOMY FOR AORTOESOPHAGEAL FISTULA
Authors: Nakamura Tetsu , Ishida Sonoko , Hasegawa Hiroshi , Yamamoto Masashi , Kanaji Shingo , Matsuda Yoshiko , Yamashita Kimihiro , Matsuda Takeru , Oshikiri Taro , Sumi Yasuo , Suzuki Satoshi , Kakeji Yoshihiro 
Published: September 2018

Abstract

Background
Aortoesophageal fistula(AEF) had been a critical and life-threatening disease. The surgical strategy which consist of aortic graft replacement with omental wrapping, esophagectomy, and staged esophageal reconstruction achieve circulatory recovery, infection control and long term survival. The objective of this study is to evaluate surgical outcomes of pedicled jejunal transfer with microvascular augmentation as esophageal reconstruction for AEF.

Methods
14 patients with aortoesophageal fistula who underwent aortic graft replacement and esophagectomy between 2010 and 2017 at Kobe University Hospital and affiliate hospitals were enrolled in this study. Patient characteristics, operative method and clinical outcomes were obtained by retrospective chart review.

Results
All 14 patients underwent aortic graft replacement with omental wrapping, esophagectomy and staged esophageal reconstruction. 10 patients (71.4%) successfully underwent staged esophageal reconstruction of pedicled jejunal transfer with microvascular augmentation and showed no leakage and no graft loss. Median survival time in the patients who underwent esophageal reconstruction was 20.3 months from initial operation. Nine of 10 patients were alive but one patient died of sepsis ten months after esophageal reconstruction.

Conclusion
Aortic graft replacement with omental wrapping and esophaegcotomy play crucial role in the treatment of AEF. Omentum is pedicled by right epiploic artery and vein to prepare good blood flow and sufficient volume of omental wraping and, consequently, stomach without right epiploic artery and vein becomes inappropriate for esophageal conduit. Pedicled jejunal transfer with microvascular augmentation contributes good post-operative outcome. The surgical strategy for AEF, which includes aortic graft replacement with omental wrapping, esophagectomy, and staged esophageal reconstruction by pedicled jejunal transfer microvascular augmentation is feasible and promising.

Disclosure
All authors have declared no conflicts of interest.
PS01.114: HYBRID OPERATION IN TREATMENT OF TRAUMATIC AORTIC ARCH RUPTURE COMBINED WITH PSEUDOANEURYSM
Authors: Tang Shoujun , Zhou Haining 
Published: September 2018

Abstract

Background
Traumatic aortic arch rupture combined with pseudoaneurysm is a rare but life-threatening condition, on which limited reports exist. We describe the technique of one-stage hybrid open debranching and endovascular repair by using thoracic stent-graft devices deployed to cover the whole aortic arch to exclude pseudoaneurysm.

Methods
A 31-year-old male patient was admitted because of anterior chest pain with hoarseness. The patient had suffered from fractures in the femur, radius, rib, and sternum because of a traffic accident 3 months ago. He subsequently underwent femoral and radial internal fixation operations. Imageological examination revealed an aortic arch rupture with upper mediastinal pseudoaneurysm (4.0 cm × 4.8 cm × 5.0 cm) in Zone 1. A hybrid operation of debranching combined with thoracic endovascular aortic repair (TEVAR) was performed. Postoperative angiography indicated that the aneurysm was isolated, and that the proximal stent presented no internal leakage or ‘beak-like’ change.

Results
Nervous and psychiatric symptoms did not appear after the operation.Follow-up results were positive at 7 days, 1 year, and > 2 years after operation. Computed tomography angiography of the chestshowed partially absorbed hematoma and smooth reconstruction of the blood vessels.

Conclusion
The hybrid operation of debranching combined with TEVAR expanded the indications of endovascular repair, providing a new treatment option for aortic dissecting aneurysm. Hybrid procedures avoid the need for CPB, aortic cross clamping, or hypothermic circulatory arrest. Hence, the operation (anatomical bypass) was simple, and the anatomic reconstruction required less work. This technique also avoids the tumor location; thus, the tumor body and the surrounding tissues were not pulled. In conclusion, we recommend hybrid repair of the aortic arch disease as an alternative treatment for patients who are at high surgical risks for conventional repair.

Disclosure
All authors have declared no conflicts of interest.
PS01.117: TOTAL LAPAROSCOPIC MIDCOLON RETROSTERNAL ESOPHAGEAL BYPASS FOR CORROSIVE STRICTURE ESOPHAGUS
Authors: Raja Kalayarasan 
Published: September 2018

Abstract

Description
Colonic bypass for corrosive stricture of the esophagus is traditionally performed using the conventional open approach. A laparoscopic mid colon retrosternal bypass has not been reported in the literature. Total laparoscopic left colic artery based mid colon retrosternal esophageal bypass is described in this report. Method: A 25-year-old female presented with acid-induced long esophageal stricture starting at 18cm from incisors refractory to endoscopic dilatation. The laparoscopic mid colon esophageal bypass was performed using 5 abdominal ports. The essential steps are colonic mobilization and assessment of the adequacy of the mesocolic vascular arcade by clamping middle colic, right colic, and ileocolic vessels proximal to their branching, creation of the retrosternal tunnel, preparation of left colic artery based colon conduit by dividing terminal ileum proximal to ileocecal junction, neck dissection to expose cervical esophagus and delivering the colonic conduit retrosternally into the neck. Reconstruction was performed by side to side esophagocoloplasty, side to side cologastric and ileocolic anastomosis. Results: The duration of surgery was 410 minutes and blood loss was 150 mL. The patient had an uneventful postoperative course. She was started on oral semisolids on postoperative day 7 and discharged on the tenth postoperative day. At 9 months follow up the patient is euphagic to solid diet with an excellent cosmetic result. Conclusion: Total laparoscopic mid colon esophageal bypass is a feasible procedure for the management of corrosive stricture of the esophagus

Disclosure
All authors have declared no conflicts of interest.