Esophagectomy in a patient with pulmonary histoplasmosis: A case report of surgical aspects and complications (with video). (2020)

• Record Type: Journal Article
• Authors: Takeda, Flavio Roberto; Garcia, Rodrigo Nicida; de Lima, Marcelo Simas; Yogolare, Gustavo Gonçalves; Junior, Ulysses Ribeiro; Filho, Fauze Maluf; Sallum, Rubens Antonio Aissar; Cecconello, Ivan
• Is Part Of: International journal of surgery case reports. Volume 77(2020)
• Page Start: 100
• Page End: 103
• Publication Date: 2020
• Subjects: Esophageal cancer -- Histoplasmosis -- Endoscopic vacuum -- Anastomotic leak -- Case report; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2020.10.107
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: Histoplasmose is an unfrequented associated to esophageal carcinoma. Pulmonary disease may interfere in the outcome after esophagectomy. Vacuum treatment is a good option after anastomotic leakage. Abstract: Introduction: Esophagectomy is a challenging procedure associated with considerable morbidity. Previous pulmonary diseases, such as histoplasmosis fungal infection, may interfere in operative and postoperative outcomes after esophagectomy. Anastomotic leakage is one of the most feared complications after esophagectomy. However, new therapies developed such as vacuum procedure and esophageal prosthesis have been provenly beneficial. Presentation of case: We present a case with squamous cell carcinoma of the mid esophagus portion on a young patient with a pulmonary histoplasmosis history. After a multidisciplinary board, the patient underwent transhiatal esophagectomy with gastric-pull up and cervical anastomosis due to pulmonary disease. The patient later developed an anastomotic leak with mediastinal abscess. We describe this complication's management via an endoscopic vacuum system, esophageal prosthesis, and exhibit a video illustrating the technique. Discussion: We illustrate the management of esophageal cancer associated with previous pulmonary disease. Histoplasmosis may misunderstand the esophageal cancer staging, and it can contribute to anastomotic leakage occurrence. An endoscopic vacuum system is an excellent tool for treating esophagogastric anastomosis fistula after esophagectomy, even when the drainage is accumulated in the mediastinum. The esophageal prosthesis may be used after mediastinal abscess resolution. Conclusion: Treatment of the association of esophageal cancer and histoplasmosis is feasible. However, care should be taken to avoid highly potential postoperative complications.