Primary Endoscopic Repair of a Large Tracheal Rupture Through Tracheal Stoma

We describe the case of an 83-year-old man who presented with a large trauma to the membranous wall of the trachea and was treated with endoscopic primary repair of the tracheal wall through a preexisting tracheal stoma. Assessment with an optical telescope through the tracheal stoma revealed a 5-cm laceration in the membranous wall of the trachea starting immediately above the carina. The laceration was closed using continuous 4-0 monofilament polydioxanone sutures with direct visualization of tissues through a fiberoptic telescope. This approach is particularly effective in cases of traumatic rupture of the membranous trachea.

Femoro-femoral Bypass for Graft Salvage in a Renal Transplant Patient With Aorto-iliac Occlusion: A Case Report

As vascular diseases are becoming more prevalent among renal transplant recipients, complications related to renal artery anastomosis are likely to occur more often. Here we report a renal transplant patient treated with femoro-femoral bypass who had renal allograft dysfunction due to aorto-iliac occlusive disease (AIOD) proximal to renal artery anastomosis. We performed living donor renal transplantation in the left iliac fossa of a 41-year-old male. At post-transplant 30 months, he was admitted with hypertension, increase in serum creatinine, and claudication of his left leg. Doppler ultrasonography showed poor flow characteristics of the renal allograft. Total occlusion of the left common iliac artery was diagnosed on angiography. Since endovascular approach was unsuccessful, we performed right-to-left femoro-femoral bypass to provide retrograde blood flow to the renal allograft. The patient was discharged at postoperative day 3 with decreased serum creatinine, normal blood pressure, no claudication, and normal flow characteristics in Doppler ultrasonography. AIOD should be suspected in renal transplant patients in case of hypertension, allograft dysfunction, and ipsilateral leg ischemia. Femoro-femoral bypass is a safe surgical procedure that may be performed in patients who cannot be treated using an endovascular approach.

Minimally Invasive and Endoscopic Approach to Esophageal Perforation

Although esophageal perforation is rare, it is a life-threatening condition. The esophagus is very sensitive to rupture and perforation due to the absence of a serosal layer. More than half of the esophageal perforations are iatrogenic and most occur during endoscopy. Around 55% of esophageal injuries occur in the intrathoracic region, 25% in the cervical region, and 20% in the abdominal region. Clinical manifestations and mortality are related to various components such as the etiology, localization, type of injury, severity of contamination, injury to adjacent mediastinal structures, and time from perforation to treatment. When perforation occurs in the esophagus, saliva, stomach contents, bile fluid, and other secretions may pass into the mediastinum causing mediastinal emphysema, inflammation followed by mediastinal necrosis, and chemical mediastinitis. Early clinical suspicion and imaging are essential for successful treatment. Despite advances in technology and treatment, the morbidity and mortality rate due to esophageal perforation is still higher than 20% according to the reported studies. Until now, the main treatment of esophageal perforation was the surgical approach. Nowadays, endoluminal procedures such as endoscopic vacuum therapy, endoscopic stent placement, endoscopic clip closure, endoscopic suturing, and tissue adhesives have started to be applied more. In this review, the minimally invasive and endoscopic approach methods suitable for esophageal perforation according to the characteristics of the patients and the structure of the perforation were examined.

Detection of SARS-CoV-2 RNA in the Pleural Swab of a COVID-19 Patient with a Pneumothorax

Coronavirus disease 2019 (COVID-19) is a viral disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). While evaluating nasopharyngeal swabs by real-time reverse transcriptase-polymerase chain reaction (rRT-PCR) is diagnostic, thorax computed tomography (CT) findings are also guiding in diagnosis. The association of pneumothorax and pleural effusion is not common in coronavirus disease. We presented the nucleic acid detection by a pleural swab sample in a COVID-19 patient with ground-glass opacity appearance and spontaneous pneumothorax.

Diagnosis, treatment, and management of esophageal foreign bodies in patients with mental retardation: A retrospective study from three centers

BACKGROUND

This study aims to assess the outcomes and prognosis of surgical interventions aimed at removing esophageal foreign bodies in patients with mental retardation.

METHODS

Between January 2010 and January 2021, a total of 30 consecutive patients (20 males, 10 females; median age: 29.5 years; range, 2 to 57 years) with mental retardation who were diagnosed with esophageal foreign bodies and underwent surgical treatment were retrospectively analyzed. Age and sex of the patients, symptoms, type of the foreign body, esophageal stricture level, methods used for preoperative diagnosis, type of surgical procedure, postoperative complications, and length of hospital stay were recorded.

RESULTS

Seventeen (56.6%) patients had a foreign body in the first narrowing, 12 (40%) in the second narrowing, and one (3.3%) in the third narrowing. A rigid esophagoscopy was performed in all cases. However, successful removal was not achieved in two (6.6%) cases, and foreign bodies were removed through cervical esophagotomy in one (3.3%) patient and through esophagotomy with right thoracotomy in one (3.3%) patient. Postoperative complications included esophagitis in seven patients (23.3%) and wound infection and pneumonia in two patients (6.6%). The median length of hospital stay after treatment was 1.09 days in patients without complications and 3.3 days in patients with complications. There was a significant correlation between the occurrence of complications and the length of hospital stay (p=0.002). The foreign body was successfully removed in all patients, and no mortality was observed.

CONCLUSION

Early diagnosis and emergency intervention can reduce complications, particularly considering the possibility of non-food and sharp-edged foreign bodies that pose a higher risk of damaging the digestive system, in patients with mental retardation than those without such conditions.

Isolated chylothorax after penetrating trauma

A case is presented with a left traumatic chylothorax, secondary to penetrating thoracic trauma, treated by conservative therapy. With this clinical report and the review of the literature, it is concluded that conservative management should be initially performed as alternative to surgical approach.

Renal Transplantation After Thoracic Endovascular Repair of Type B Aortic Dissection--A Case Report

Because of the strong association between uremia and atherosclerosis, incidence of aortic aneurysms is increasing among renal failure patients awaiting renal transplantation (RT). Successful RTs have been performed in these patients after surgical repair of the aneurysms. Since Parodi et al introduced endovascular aortic aneurysm repair (EVAR) in patients with high risk for conventional surgery, a new era has begun. The 1st successful RT after EVAR was published in 2001. Herein we report the 1st successful RT after thoracic EVAR (TEVAR) reported to date. We performed RT in a 54-year-old man with end-stage renal failure due to diabetic nephropathy, who had undergone TEVAR for type B aortic dissection (TBAD) 6 months earlier. The postoperative period was uneventful and the patient was discharged from the hospital at postoperative day 6 with a serum creatinine of 0.9 mg/dL. At follow-up examination at postoperative 6 months, graft function was stable. Because of its advantages over open surgery, including low mortality and morbidity, TEVAR is becoming more common among renal failure patients with thoracic aortic aneurysms and TBAD. Our case shows that successful RT can be performed in renal failure patients who have undergone TEVAR.

An Unusual Cause of Pulmonary Arterial Hypertension: Hydatid Cyst

Hydatid cyst is an important health problem throughout the world, and it is caused by the larval form of Echinococcus granulosus. Although it is most commonly located in the liver and lungs, hydatid cyst can also affect other organs because the oncospheres spread through the bloodstream. The disease may have many different clinical presentations. Although it is a benign disease, sometimes it can cause serious morbidity and even mortality. Here, the case of a 33-year-old male patient who underwent surgery for a right ventricle and bilateral lung hydatid cyst 9 years ago and had pulmonary hypertension is presented.

Is thoracic esophagostomy an option in esophageal perforation in pediatric patients?

Esophagostomy and subsequent esophagectomy are extremely rare operations in the management of benign esophageal perforations in children. In this report, we present a 20-month-old female in whom we performed thoracic esophagostomy and subsequent intrathoracic esophagogastric anastomosis due to esophageal perforation caused by a chronic foreign body. The patient was discharged on the 10th postoperative day, and no complications were observed in the patient, who was followed for four years. The thoracic esophagostomy procedure helps preserve the esophageal length and easy execution of the esophagogastric anastomosis in the thorax. We believe it can be a safe and useful technique in carefully selected cases.

Pulmonary Hamartomas: A Single-Center Analysis of 59 Cases

OBJECTIVE

This study investigated the clinical, radiological, and surgical treatment results of patients who underwent surgical treatment for pulmonary hamartomas.

MATERIALS AND METHODS

Fifty-nine consecutive patients who underwent surgical treatment for pulmonary hamartomas in our clinic between January 2001 and February 2021 were analyzed retrospectively.

RESULTS

Forty-three out of 59 (72.9%) of the cases were male and 16 (27.1%) were female. The average age was 52.0 ± 15.0 (between 5 years and 80 years). While pulmonary hamartoma was in the form of a solitary pulmonary nodule in 55 (93.2%) of the cases, there were multiple lesions in 4 (6.8%) cases. Simultaneous gastric adenocarcinoma was detected in 1 patient. One case had been operated on for Wilms tumor. Twenty-two (37.3%) of the cases were asymptomatic and were detected incidentally. Locations of pulmonary hamartomas were 18 (29.0%) in the left lower lobe, 16 (25.8%) in the right upper lobe, 12 (19.4%) in the right lower lobe, 9 (14.5%) in the left upper lobe, and 7 (11.3%) in the right middle lobe. The mean lesion diameter was 22.0 ± 9.5 mm (between 10 mm and 56 mm). Mild to moderate fluorodeoxyglucose (FDG) uptake was observed in 11 of 15 cases that were evaluated with positron emission tomography/computed tomography. Surgically, 44 (74.6%) patients underwent wedge resection, 13 (22.0%) patients underwent enucleation and two (3.4%) patients underwent lobectomy. Perioperative morbidity and mortality were not observed in any of the cases. The cases were followed up for an average of 40.6 ± 38.7 months (between 1 month and 151 months). No recurrence was observed in any of the cases during follow-up.

CONCLUSION

Pulmonary hamartomas are usually detected incidentally and as a solitary pulmonary nodule. Although radiological findings provide important information, a definitive diagnosis is usually made during surgery. Parenchyma-sparing surgery should be preferred in these cases whenever possible.

An important finding for differential diagnosis in thymic cyst mimicking pericardial cyst: punctate calcification

Mediastinal cysts are usually congenital but present in adulthood. A pericardial cyst is usually localized in the right cardiophrenic region. Thymic cysts are less common and are located in the cervical region or anterior mediastinal region. While thoracoscopic excision or aspiration can be applied in pericardial cysts, excision is recommended in thymic cysts. We present a case of a thymic cyst located in the localization of the pericardial cyst and radiologically containing wall punctate calcification.