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Ola M, Zahra EMF, Amine C, Omar EA, Laila J, Zahra LF. Jejunocolic intussusception after colonic esophageal interposition-A case report. SAGE Open Med Case Rep 2024; 12:2050313X241266425. [PMID: 39055672 PMCID: PMC11271082 DOI: 10.1177/2050313x241266425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 06/18/2024] [Indexed: 07/27/2024] Open
Abstract
The management of gastrointestinal complications in patients with complex medical history poses significant challenges to healthcare clinicians. A 42-year-old male patient was admitted to the emergency department with excruciating abdominal pain and signs of bowel obstruction. The patient had a previous history of schizophrenia and esophageal stricture, treated 6 years ago with colonic esophageal interposition. From the computed tomography scan, intussusception of the jejunum in the colonic graft was revealed, which resolved spontaneously after a few hours probably due to the oral contrast. Although, colonic esophageal interposition is a life-saving procedure for long-esophageal strictures, there are rare complications that are still not clearly reported. Jejunocolic intussusception should raise awareness of the clinicians, as one of the potential complications of colonic esophageal interposition.
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Affiliation(s)
- Messaoud Ola
- Emergency Radiology Department of the University Hospital Ibn Sina, Rabat, Morocco
| | | | - Cherraqi Amine
- Emergency Radiology Department of the University Hospital Ibn Sina, Rabat, Morocco
| | - El Aoufir Omar
- Emergency Radiology Department of the University Hospital Ibn Sina, Rabat, Morocco
| | - Jroundi Laila
- Emergency Radiology Department of the University Hospital Ibn Sina, Rabat, Morocco
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SANI R, ZABEIROU A, SALHA I, ISS OUF OU ALZOUMA I, DJAFAROU ABARCHI B, JAMES DIDIER L, SANI R, ABARCHI H. [Results of emergency management of esophageal lesions related to caustic ingestion in children in the emergency department of the General Reference Hospital of Niamey (Niger)]. MEDECINE TROPICALE ET SANTE INTERNATIONALE 2024; 4:mtsi.v4i1.2024.399. [PMID: 38846116 PMCID: PMC11151903 DOI: 10.48327/mtsi.v4i1.2024.399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 11/21/2023] [Indexed: 06/09/2024]
Abstract
Introduction Caustic ingestion in children is a public health problem; it is mainly due to domestic accidents due to improper packaging and storage of caustic products. It is a medical and surgical emergency whose management is multidisciplinary. The lesions caused by the accidental ingestion of caustics can affect the functional and vital prognosis in 10% of cases. Methodology A retrospective, descriptive study from January 2020 to December 2022 (2 years), carried out in the emergency department of the General Reference Hospital of Niamey (Niger). The study included patients less than 15 years old admitted for ingesting a caustic product. Results Our study included 17 patients. The average age was 5 years, with age extremes of 2 to 11 years. We noted a male predominance with a sex ratio (M/F) of 2.4. Ingestion of caustic products was accidental in all cases. The caustic product was caustic soda in 59%. The average quantity of product ingested was 5 ml (2 ml to 20 ml). The average consultation time was 3 days (3 hours to 15 days). Clinically, dysphagia was the most functional sign, represented by 13 cases, or 76%. Regarding general signs, 3 patients (18%) were admitted with fever; blood pressure was normal in 15 patients (88%); and 2 patients (18%) were admitted in a state of shock. The respiratory rate was normal in 14 patients (82%). Four patients (24%) were admitted in a state of deterioration in the general condition associated with severe malnutrition and dehydration. On physical examination, 2 patients (12%) presented with abdominal defense at the epigastric level. Examination of the ENT sphere revealed benign buccopharyngeal ulcerations in 2 patients (12%). Esogastroduodenal fibroscopy was performed in 4 patients (24%). The caustic lesions observed in the esophagus were: Zargar stage I at 25%, stage Ila at 50%, and stage Illb at 25%. In the stomach, the lesions were Zargar stage I in 75% of cases and stage III in 25% of cases. An injected thoracic-abdominopelvic computed tomography (CT) was performed in 3 patients (18%). It revealed a lack of enhancement of the esophageal wall compatible with esophageal necrosis in one patient. An esophagogastroduodenal transit was performed in 8 patients (47%) admitted more than 72 hours after ingestion of the caustic. They showed esophageal stenoses longer than 3 cm in 3 patients, multiple esophageal stenoses in 2 patients, a single esophageal stenosis in 2 patients, and a single antropyloric stenosis in 1 patient. Therapeutically, all patients benefited from antiemetics to avoid vomiting and proton pump inhibitors. Intravenous antibiotic prophylaxis with third-generation cephalosporin was administered to 12 patients (71%). Corticosteroid therapy based on IV prednisolone at a dose of 1 g/1.73 m2 per day was used to limit or prevent stenoses in 9 patients (53%). Parenteral nutrition was administered to 7 patients (41%). Endoscopic dilations were performed in 2 patients (12%). Emergency surgical treatment was performed in 7 patients (41%): 3 patients underwent transitional feeding gastrostomies; in 3 others, esophagoplasties by colon transplant were performed, and 1 patient was treated by stripping of the esophagus associated with total gastrectomy. The postoperative course was marked by a leak of esocolic anastomosis in one patient for whom conservative treatment was performed with good progress. The average length of hospital stay was 5 days (1-32 days). Conclusion Accidental caustic ingestions can have serious consequences. Preventing these accidents relies on raising public awareness of the dangers associated with improper storage of these products.
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Affiliation(s)
- Rabiou SANI
- Service de chirurgie thoracique et cardiovasculaire, Hôpital général de référence, Niamey, Niger
- Faculté des sciences de la santé, Université Abdou Moumouni, Niamey, Niger
| | - Aliou ZABEIROU
- Service de chirurgie générale et digestive, Hôpital général de référence, Niamey, Niger
| | - Illé SALHA
- Service dotorhinolaryngologie, Hôpital général de référence, Niamey, Niger
- Faculté des sciences de la santé, Université Abdou Moumouni, Niamey, Niger
| | | | - Boubé DJAFAROU ABARCHI
- Service dotorhinolaryngologie, Hôpital général de référence, Niamey, Niger
- Faculté des sciences de la santé, Université Abdou Moumouni, Niamey, Niger
| | | | - Rachid SANI
- Faculté des sciences de la santé, Université Abdou Moumouni, Niamey, Niger
| | - Habibou ABARCHI
- Faculté des sciences de la santé, Université Abdou Moumouni, Niamey, Niger
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Godefroy W, Faivre L, Sansac C, Thierry B, Allain JM, Bruneval P, Agniel R, Kellouche S, Monasson O, Peroni E, Jarraya M, Setterblad N, Braik M, Even B, Cheverry S, Domet T, Albanese P, Larghero J, Cattan P, Arakelian L. Development and qualification of clinical grade decellularized and cryopreserved human esophagi. Sci Rep 2023; 13:18283. [PMID: 37880340 PMCID: PMC10600094 DOI: 10.1038/s41598-023-45610-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/21/2023] [Indexed: 10/27/2023] Open
Abstract
Tissue engineering is a promising alternative to current full thickness circumferential esophageal replacement methods. The aim of our study was to develop a clinical grade Decellularized Human Esophagus (DHE) for future clinical applications. After decontamination, human esophagi from deceased donors were placed in a bioreactor and decellularized with sodium dodecyl sulfate (SDS) and ethylendiaminetetraacetic acid (EDTA) for 3 days. The esophagi were then rinsed in sterile water and SDS was eliminated by filtration on an activated charcoal cartridge for 3 days. DNA was removed by a 3-hour incubation with DNase. A cryopreservation protocol was evaluated at the end of the process to create a DHE cryobank. The decellularization was efficient as no cells and nuclei were observed in the DHE. Sterility of the esophagi was obtained at the end of the process. The general structure of the DHE was preserved according to immunohistochemical and scanning electron microscopy images. SDS was efficiently removed, confirmed by a colorimetric dosage, lack of cytotoxicity on Balb/3T3 cells and mesenchymal stromal cell long term culture. Furthermore, DHE did not induce lymphocyte proliferation in-vitro. The cryopreservation protocol was safe and did not affect the tissue, preserving the biomechanical properties of the DHE. Our decellularization protocol allowed to develop the first clinical grade human decellularized and cryopreserved esophagus.
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Affiliation(s)
- William Godefroy
- Service de Chirurgie Viscérale, Cancérologique et Endocrinienne, Hôpital Saint-Louis - Université Paris Cité, Paris, France.
- Unité de Thérapie Cellulaire, Hôpital Saint-Louis, AP-HP, Paris, France.
- CIC de Biothérapies CBT 501, Paris, France.
- Human Immunology, Pathophysiology, Immunotherapy / HIPI / INSERM UMR976, Laboratoire de Biotechnologies de Cellules Souches, Université Paris Cité, 75010, Paris, France.
| | - Lionel Faivre
- Unité de Thérapie Cellulaire, Hôpital Saint-Louis, AP-HP, Paris, France
- CIC de Biothérapies CBT 501, Paris, France
- Human Immunology, Pathophysiology, Immunotherapy / HIPI / INSERM UMR976, Laboratoire de Biotechnologies de Cellules Souches, Université Paris Cité, 75010, Paris, France
| | - Caroline Sansac
- Banque de Tissus Humains, Hôpital St-Louis, AP-HP, Paris, France
| | - Briac Thierry
- Human Immunology, Pathophysiology, Immunotherapy / HIPI / INSERM UMR976, Laboratoire de Biotechnologies de Cellules Souches, Université Paris Cité, 75010, Paris, France
- Service d'ORL Pédiatrique, AP-HP, Hôpital Universitaire Necker, 75015, Paris, France
| | - Jean-Marc Allain
- LMS, CNRS, Ecole Polytechnique, Institut Polytechnique de Paris, Palaiseau, France
- Inria, Paris, France
| | - Patrick Bruneval
- Service d'Anatomie Pathologie, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - Rémy Agniel
- Equipe de Recherche sur les Relations Matrice Extracellulaire-Cellules, ERRMECe (EA1391), Institut des Matériaux, I-MAT (FD4122), CY Cergy Paris Université, Cergy-Pontoise, France
| | - Sabrina Kellouche
- Equipe de Recherche sur les Relations Matrice Extracellulaire-Cellules, ERRMECe (EA1391), Institut des Matériaux, I-MAT (FD4122), CY Cergy Paris Université, Cergy-Pontoise, France
| | - Olivier Monasson
- CNRS, BioCIS, CY Cergy Paris Université, 95000, Cergy Pontoise, France
- CNRS, BioCIS, Université Paris-Saclay, 92290, Châtenay-Malabry, France
| | - Elisa Peroni
- CNRS, BioCIS, CY Cergy Paris Université, 95000, Cergy Pontoise, France
- CNRS, BioCIS, Université Paris-Saclay, 92290, Châtenay-Malabry, France
| | - Mohamed Jarraya
- Banque de Tissus Humains, Hôpital St-Louis, AP-HP, Paris, France
| | - Niclas Setterblad
- UMS Saint-Louis US53 / UAR2030, Institut de Recherche Saint-Louis Plateforme Technologique Centre, Université Paris Cité - Inserm - CNRS, Paris, France
| | - Massymissa Braik
- Unité de Thérapie Cellulaire, Hôpital Saint-Louis, AP-HP, Paris, France
| | - Benjamin Even
- Laboratoire Gly-CRRET, Université Paris Est Créteil, Université Paris Est, EA 4397 ERL CNRS 9215, Créteil, France
| | - Sophie Cheverry
- Laboratoire Gly-CRRET, Université Paris Est Créteil, Université Paris Est, EA 4397 ERL CNRS 9215, Créteil, France
| | - Thomas Domet
- Unité de Thérapie Cellulaire, Hôpital Saint-Louis, AP-HP, Paris, France
- CIC de Biothérapies CBT 501, Paris, France
| | - Patricia Albanese
- Laboratoire Gly-CRRET, Université Paris Est Créteil, Université Paris Est, EA 4397 ERL CNRS 9215, Créteil, France
| | - Jérôme Larghero
- Unité de Thérapie Cellulaire, Hôpital Saint-Louis, AP-HP, Paris, France
- CIC de Biothérapies CBT 501, Paris, France
- Human Immunology, Pathophysiology, Immunotherapy / HIPI / INSERM UMR976, Laboratoire de Biotechnologies de Cellules Souches, Université Paris Cité, 75010, Paris, France
- Centre MEARY de Thérapie Cellulaire Et Génique, AP-HP, Hôpital Saint-Louis, 75010, Paris, France
| | - Pierre Cattan
- Service de Chirurgie Viscérale, Cancérologique et Endocrinienne, Hôpital Saint-Louis - Université Paris Cité, Paris, France
- Unité de Thérapie Cellulaire, Hôpital Saint-Louis, AP-HP, Paris, France
- CIC de Biothérapies CBT 501, Paris, France
- Human Immunology, Pathophysiology, Immunotherapy / HIPI / INSERM UMR976, Laboratoire de Biotechnologies de Cellules Souches, Université Paris Cité, 75010, Paris, France
| | - Lousineh Arakelian
- Unité de Thérapie Cellulaire, Hôpital Saint-Louis, AP-HP, Paris, France.
- CIC de Biothérapies CBT 501, Paris, France.
- Human Immunology, Pathophysiology, Immunotherapy / HIPI / INSERM UMR976, Laboratoire de Biotechnologies de Cellules Souches, Université Paris Cité, 75010, Paris, France.
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Ferrante F, Bassi M, Diso D, Ferreira Vaz Sousa R, Paganini AM, Venuta F, De Giacomo T. A challenging upper digestive tract continuity restoration after recurrent esophago-colonic anastomosis complications. J Cardiothorac Surg 2022; 17:318. [PMID: 36527148 PMCID: PMC9758817 DOI: 10.1186/s13019-022-02085-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 12/11/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Acute and chronic complications in esophago-colonic anastomosis have a significant impact in the postoperative course of patients with colonic transposition. Evidence about their management is poor and surgical treatment is mostly based on tailored approaches, so each new experience could be useful to improve knowledge about this peculiar condition. We report a unique case of an esophago-colonic resection and re-anastomosis without sternal approximation after recurrent anastomosis failure and strictures. CASE PRESENTATION A 69-year-old woman was referred to our hospital for worsening dysphagia. The patient had undergone esophago-gastrectomy with right colon interposition 12 years prior due to caustic ingestion. The esophago-colonic anastomosis was initially complicated by an enterocutaneous fistula, which was treated with anastomosis resection and left colon transposition. This was then further complicated by dehiscence and sternal infection treated with resection of the distal portion of the sternum and a new colo-jejunal anastomosis. Finally, a chronic anastomotic stricture occurred, refractory to endoscopic dilatation and prothesis positioning. We planned a new colonic-esophageal resection and re-anastomosis. The main technical challenges were addressing the adhesions resulting from previous surgery and mobilizing an adequate length of the intestinal tract to allow conduit continuity restoration. Blood supply was assessed through Indocyanine Green Fluorescence. To avoid compression of the digestive conduit sternal margins were not re-approximated, and the transposed tube was covered and protected using both pectoralis major muscles flap. We decided to avoid the use of any prosthetic material to reduce the risk of infection. The patient was able to resume oral food intake on the 12th day postoperatively after a barium swallowing test showed an adequate conduit caliber. CONCLUSION Esophago-colonic anastomosis complications represent a life-threatening condition. Therefore, reports and sharing of knowledge are important to improve expertise in management of these conditions.
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Affiliation(s)
- Francesco Ferrante
- grid.7841.aDepartment of Thoracic Surgery, “Sapienza” University of Rome, Policlinico Umberto I Rome, Viale del Policlinico, 155, 00161 Rome, Italy
| | - Massimiliano Bassi
- grid.7841.aDepartment of Thoracic Surgery, “Sapienza” University of Rome, Policlinico Umberto I Rome, Viale del Policlinico, 155, 00161 Rome, Italy
| | - Daniele Diso
- grid.7841.aDepartment of Thoracic Surgery, “Sapienza” University of Rome, Policlinico Umberto I Rome, Viale del Policlinico, 155, 00161 Rome, Italy
| | - Rita Ferreira Vaz Sousa
- grid.7841.aDepartment of Thoracic Surgery, “Sapienza” University of Rome, Policlinico Umberto I Rome, Viale del Policlinico, 155, 00161 Rome, Italy
| | - Alessandro Maria Paganini
- grid.7841.aDepartment of Bariatric Surgery, “Sapienza” University of Rome, Policlinico Umberto I Rome, Rome, Italy
| | - Federico Venuta
- grid.7841.aDepartment of Thoracic Surgery, “Sapienza” University of Rome, Policlinico Umberto I Rome, Viale del Policlinico, 155, 00161 Rome, Italy
| | - Tiziano De Giacomo
- grid.7841.aDepartment of Thoracic Surgery, “Sapienza” University of Rome, Policlinico Umberto I Rome, Viale del Policlinico, 155, 00161 Rome, Italy
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Hall AH, Jacquemin D, Henny D, Mathieu L, Josset P, Meyer B. Corrosive substances ingestion: a review. Crit Rev Toxicol 2020; 49:637-669. [PMID: 32009535 DOI: 10.1080/10408444.2019.1707773] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Corrosive chemical substance ingestions are a major problem, especially in developing countries, but also in developed countries such as the United States, France, and Belgium. Ingestions may be deliberate as suicide attempts (mostly in adolescents and adults) or accidental (mostly in children). The results can be devastating in terms of individual suffering and disability, but also in terms of resource utilization and costs. In developing countries, outcomes may be worse because of limited medical/surgical resources. Common sequelae include gastrointestinal (GI) tract (esophagus, stomach, pylorus, and duodenum) stricture formation, GI tract perforation, and hemorrhage. Systemic effects may also occur, such as disseminated intravascular coagulation (DIC), multi-organ system failure, and sepsis. Various interventions in the acute phase to reduce the severity of injury have been attempted, but there are no large controlled clinical trials to demonstrate efficacy. Dilation therapy in various forms is commonly used for the treatment of strictures and a variety of surgical procedures including esophagectomy and delayed replacement may be required in severe corrosive injury cases.
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Affiliation(s)
- Alan H Hall
- Toxicology Consulting and Medical Translating Services, Azle and Springtown, TX, USA.,Colorado School of Public Health, University of Colorado-Denver, Denver, CO, USA
| | | | | | | | - Patrice Josset
- Department of Pathology, Hôpital d'Enfants Armand Trousseau, Director of the Teaching Program of the History of Medicine, Université Pierre et Marie Curie, Paris, France
| | - Bernard Meyer
- Department of Otorhinolaryngology, Université Pierre et Marie Curie, Groupe Hospitalier Pieté-Salpêtrière, Paris, France
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Colon Interposition for Corrosive Esophageal Stricture: Single Institution Experience with 119 Cases. Curr Med Sci 2019; 39:415-418. [DOI: 10.1007/s11596-019-2052-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 01/22/2019] [Indexed: 12/31/2022]
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Johnson M, Nielsen JW, Yalamanchilli H, Thakkar RK, Diefenbach K, Kenney B, Hogan M, Fabia R. Simultaneous internal and external chemical injuries. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2018. [DOI: 10.1016/j.epsc.2018.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Original treatment for ischaemic stenosis of colon interposition: Report of two cases. Eur Ann Otorhinolaryngol Head Neck Dis 2016; 134:43-45. [PMID: 27568402 DOI: 10.1016/j.anorl.2016.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The treatment of ischaemic stenosis of colon interposition for oesophageal replacement remains poorly defined. CASE REPORT We report two cases of patients operated for ischaemic stenosis of the cervical extremity of the colon interposition for caustic stenosis of the oesophagus. Treatment consisted of resection of the stenosis with creation of a new cervical anastomosis after complete release of the colon graft via a neck and upper midline incision in one patient and a new ileocolic graft exclusively replacing the stenotic segment of the oesophagoplasty in the second patient. DISCUSSION These two cases illustrate the complex treatment modalities required for this complication. CONCLUSION The treatment of choice of ischaemic stenosis of colon interposition is resection with creation of a new anastomosis, but repeat graft may sometimes be the only available treatment option.
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Ezemba N, Eze JC, Nwafor IA, Etukokwu KC, Orakwe OI. Colon interposition graft for corrosive esophageal stricture: midterm functional outcome. World J Surg 2015; 38:2352-7. [PMID: 24748346 DOI: 10.1007/s00268-014-2574-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Corrosive esophageal stricture is a major cause of morbidity among Nigerians. In most cases, this follows accidental or parasuicidal ingestion of caustic sodium hydroxide solution (NaOH) often used in the local production of soaps. Various treatment modalities have been advocated for the treatment of esophageal stricture. In this study, we review the results of our adopted technique in the past 10 years for pedicled colonic interposition. METHODS This is a retrospective study of 21 patients who underwent substernal isoperistaltic pedicled colonic interposition graft for management of corrosive esophageal stricture. The right colon was pulled up into the neck in all the patients without resecting the strictured esophagus. RESULTS Long segment strictures and multiple strictures were the main indications for the procedure. The mean duration of the procedure was 339.6 ± 71.1 min. The average intraoperative blood loss was 673.1 ± 398.1 mL. There were two (9.5 %) hospital mortalities. Graft infarction (9.5 %), cervical fistulae (19.0 %), and reflux neo-esophagitis (14.3 %) were the main non-fatal complications. In the mid-term, dysphagia was completely relieved in a little over 84 % (16/19) of patients, while one patient (4.8 %) still experienced reflux neo-esophagitis requiring treatment. There was no case of gross regurgitation or nocturnal aspiration in the mid-term. CONCLUSIONS Although the use of pedicled colonic interposition graft offers a good mid-term functional outcome with relief of dysphagia, early postoperative morbidity is high. Graft infarction is the single most important factor for poor functional outcome and every effort must be made to prevent its occurrence.
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Affiliation(s)
- Ndubueze Ezemba
- Division of Cardiothoracic Surgery, National Cardiothoracic Center, University of Nigeria Teaching Hospital, Ituku-Ozalla, PMB 01129, Enugu, 400001, Nigeria,
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Poghosyan T, Sfeir R, Michaud L, Bruneval P, Domet T, Vanneaux V, Luong-Nguyen M, Gaujoux S, Gottrand F, Larghero J, Cattan P. Circumferential esophageal replacement using a tube-shaped tissue-engineered substitute: An experimental study in minipigs. Surgery 2015; 158:266-77. [PMID: 25796416 DOI: 10.1016/j.surg.2015.01.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 01/14/2015] [Accepted: 01/29/2015] [Indexed: 01/02/2023]
Abstract
BACKGROUND Esophageal replacement by the colon or the stomach for malignant and nonmalignant esophageal diseases exposes to significant morbidity and mortality. In this setting, tissue engineering seems to be a seductive alternative. METHODS In a porcine model, we performed a 5-cm-long circumferential replacement of the cervical esophagus by a tubulized acellular matrix (small intestinal submucosa) cellularized with autologous skeletal myoblasts and covered by a human amniotic membrane seeded with autologous oral epithelial cells. The substitute was grown for 2 weeks in the great omentum before esophageal replacement. Eighteen minipigs (divided into 3 groups: group A [substitute with esophageal endoprothesis; n = 6], group B [substitute alone; n = 6], and group C [endoprothesis alone; n = 6]) were included. The esophageal endoprothesis was removed at 6 months. Animals were killed sequentially over a 12 month-period. Clinical, endoscopic, radiologic and histologic outcomes were analyzed. RESULTS All animals except 1 of in groups B and C died during the first 2 months owing to refractory esophageal stenosis or endoprothesis extrusion. Nutritional autonomy without endoprothesis was observed in all animals of group A with a follow-up of >6 months (n = 3). A phenotype similar to that of native esophagus, consisting of a mature epithelium, submucosal glands, and a circular muscular layer, was observed after 9 months. CONCLUSION In this model, the circumferential replacement of the cervical esophagus by a tube-shaped tissue-engineered substitute under the temporary cover of an esophageal endoprothesis allowed nutritional autonomy and tissue remodeling toward an esophageal phenotype.
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Affiliation(s)
- Tigran Poghosyan
- Cell Therapy Unit and CIC-BT, Saint-Louis Hospital, AP-HP, Paris, France; Department of Digestive and Endocrine Surgery, Saint-Louis Hospital, AP-HP, Paris, France; Inserm UMR 1160, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.
| | - Rony Sfeir
- Department of Pediatric Surgery, Jeanne de Flandre Hospital and Université Lille 2, Lille, France
| | - Laurent Michaud
- Reference Center for Congenital and Malformative Esophageal Diseases, Department of Pediatric Gastroenterology and Nutrition, Jeanne de Flandre Hospital and Université Lille 2, Lille, France
| | - Patrick Bruneval
- Department of Pathology, Georges Pompidou European Hospital, AP-HP, Paris, France
| | - Thomas Domet
- Cell Therapy Unit and CIC-BT, Saint-Louis Hospital, AP-HP, Paris, France
| | - Valerie Vanneaux
- Cell Therapy Unit and CIC-BT, Saint-Louis Hospital, AP-HP, Paris, France; Inserm UMR 1160, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Minh Luong-Nguyen
- Cell Therapy Unit and CIC-BT, Saint-Louis Hospital, AP-HP, Paris, France; Inserm UMR 1160, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Sebastien Gaujoux
- Department of Digestive and Endocrine Surgery, Cochin Hospital, AP-HP, Paris, France
| | - Frederic Gottrand
- Reference Center for Congenital and Malformative Esophageal Diseases, Department of Pediatric Gastroenterology and Nutrition, Jeanne de Flandre Hospital and Université Lille 2, Lille, France
| | - Jerome Larghero
- Cell Therapy Unit and CIC-BT, Saint-Louis Hospital, AP-HP, Paris, France; Inserm UMR 1160, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Pierre Cattan
- Cell Therapy Unit and CIC-BT, Saint-Louis Hospital, AP-HP, Paris, France; Department of Digestive and Endocrine Surgery, Saint-Louis Hospital, AP-HP, Paris, France; Inserm UMR 1160, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
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Badshah MB, Riaz H, Korsten MA, Dhala A, Park YHA, Abadi M, Badshah MB. Gastro-intestinal stromal tumor (GIST) complicating a colonic interposition: a novel case report. BMC Res Notes 2014; 7:604. [PMID: 25185706 PMCID: PMC4167284 DOI: 10.1186/1756-0500-7-604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Accepted: 04/16/2014] [Indexed: 12/02/2022] Open
Abstract
Background Gastrointestinal stromal tumor (GIST) is a rare tumor comprising 0.1-0.3% of all gastrointestinal (GI) malignancies. Stomach followed by small intestine is the most common sites of involvement, implicated in 95% of the cases. We present a case of GIST complicating a colonic interposition. To the best of the author's knowledge, this is the first reported case of GIST complicating a colonic interposition. Case presentation A 47 year old African American male presented to the emergency department with intermittent, severe chest pain. Past medical history was significant for alkali (NaOH) ingestion during 1980 for which esophageal resection and a colonic pull-through was performed. A CXR revealed a widened mediastinum and CT scan chest revealed showed a large (11.4 × 8.3 × 12.1 cm) vascular mediastinal mass. At endoscopy, a large, ulcerated, cratered and friable mass was found at 29cm extending to 36cm at which point the lower anastomosis of the colonic pull through was present. Multiple endoscopic biopsies were obtained which showed that the tumor was immunoreactive with CD117, CD34 and DOG1 while markers of carcinoma, melanoma and lymphoma were negative. In light of the pathology report, the immunohistochemistry and the CT scans, the tumor was classified as a stage 4 GIST of colonic interposition. Conclusions GIST can complicate unusual locations such as colonic interposition and should be kept in the differential diagnosis of such unusual presentations.
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Affiliation(s)
| | - Haris Riaz
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
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Poghosyan T, Gaujoux S, Vanneaux V, Bruneval P, Domet T, Lecourt S, Jarraya M, Sfeir R, Larghero J, Cattan P. In vitro development and characterization of a tissue-engineered conduit resembling esophageal wall using human and pig skeletal myoblast, oral epithelial cells, and biologic scaffolds. Tissue Eng Part A 2013; 19:2242-52. [PMID: 23672649 DOI: 10.1089/ten.tea.2012.0565] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Tissue engineering represents a promising approach for esophageal replacement, considering the complexity and drawbacks of conventional techniques. AIM To create the components necessary to reconstruct in vitro or in vivo an esophageal wall, we analyzed the feasibility and the optimal conditions of human and pig skeletal myoblast (HSM and PSM) and porcine oral epithelial cell (OEC) culture on biologic scaffolds. MATERIALS AND METHODS PSM and HSM were isolated from striated muscle and porcine OECs were extracted from oral mucosa biopsies. Myoblasts were seeded on an acellular scaffold issue from porcine small intestinal submucosa (SIS) and OEC on decellularized human amniotic membrane (HAM). Seeding conditions (cell concentrations [0.5×10(6) versus 10(6) cells/cm(2)] and culture periods [7, 14 and 21 days]), were analyzed using the methyl thiazoltetrazolium assay, quantitative PCR, flow cytometry, and immunohistochemistry. RESULTS Phenotypic stability was observed after cellular expansion for PSM and HSM (85% and 97% CD56-positive cells, respectively), and OECs (90% AE1/AE3- positive cells). After PSM and HSM seeding, quantities of viable cells were similar whatever the initial cell concentration used and remained stable at all time points. During cell culture on SIS, a decrease of CD56-positive cells was observed (76% and 76% by D7, 56% and 70% by D14, 28% and 60% by D21, for PSM and HSM, respectively). Multilayered surface of α-actin smooth muscle and Desmine-positive cells organized in bundles was seen as soon as D7, with no evidence of cell within the SIS. Myoblasts fusion was observed at D21. Pax3 and Pax7 expression was downregulated and MyoD expression upregulated, at D14.OEC proliferation was observed on HAM with both cell concentrations from D7 to D21. The cell metabolism activity was more important on matrix seeded by 10(6) cells/cm(2). With 0.5×10(6) OEC/cm(2), a single layer of pancytokeratin-positive cells was seen at D7, which became pluristratified by D14, while when 10(6) OEC/cm(2) were used, a pluristratified epithelial structure was seen as soon as D7. Proliferative cells (Proliferating Cell Nuclear Antigen staining) were mainly located at the basal layer. CONCLUSION In this model, the optimal conditions of cell seeding in terms of cell concentration and culture duration were 0.5×10(6) myoblasts/cm(2) and 10(6) OEC/cm(2), and 7 days.
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Affiliation(s)
- Tigran Poghosyan
- Cell Therapy Unit and Clinical Investigation Center in Biotherapies (CIC-BT501), Saint-Louis Hospital, AP-HP Paris, France
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Abstract
We studied ultrastructural reorganization of the colon transplant in delayed period after esophagoplasty. It was found that during functioning of the artificial esophagus, a complex of adaptive and pathologic processes occurs in the mucosa. Focal sclerosis of the mucosa and slight epithelial degeneration with hyperplasia and hypersecretion of goblet cells were found in biopsy specimens with stenosis of the anastomosis. In case of colonopathy of the transplant, more pronounced epithelial degeneration and proliferation accompanied by abundant polymorphocellular stromal infiltration were seen. Deformation of the transplant was characterized by progressive atrophic and sclerotic reorganization of the mucosa. Goblet cells with ultrastructural signs of hypersecretion predominated in the population of epithelial cells of the colon transplant; oligomucus and poorly differentiated cell and colonocytes with signs of alteration and degenerative changes in cytoplasmic organelles were also found.
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14
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Mas E, Breton A, Lachaux A. [Management of caustic esophagitis in children]. Arch Pediatr 2012; 19:1362-8. [PMID: 23141564 DOI: 10.1016/j.arcped.2012.09.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Revised: 08/30/2012] [Accepted: 09/23/2012] [Indexed: 01/29/2023]
Abstract
In children, caustic ingestion is due to accidents at home and inadequate storage of caustic agents. In emergency, it is useful to remove the soiled clothes, rinse the affected area, and prevent vomiting and feeding. Caustic ingestion (pH<2 or>12) induces burns of the upper gastrointestinal tract requiring esophagogastro-duodenoscopy between H12 and H24. Strong alkalis cause necrosis with liquefaction of the esophagus, penetrating deeply with a high-risk of perforation. Management of these children requires a specialized care center with an intensive care unit, endoscopic equipment, and a surgical team. Esophageal stricture is the main complication; no prophylactic treatment (steroids) is effective. Strictures occur after the 3rd week, and barium swallow should be performed by the end of the 1st month. Stricture are often multiple, long, and tortuous; endoscopic dilatation is difficult with a high-rate of perforation and a low-rate of success. In situ application of mitomycin C or injection of triamcinolone could reduce the recurrence rate of stricture. In recalcitrant or recurrent strictures, it is recommended to perform an esophageal replacement using a colonic interposition or a gastric tube. Endoscopy should also be performed 15-20years after caustic ingestion to screen for early neoplastic lesions. Prevention is very important for avoiding caustic ingestions. Information and education should be given specifically to the parents of toddlers; caustic products should be stored out of reach of children and they should not be kept with food.
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Affiliation(s)
- E Mas
- Unité de gastroentérologie, hépatologie, nutrition et diabétologie, hôpital des Enfants, 330, avenue de Grande-Bretagne, TSA 70034, 31300 Toulouse cedex 9, France.
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15
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Miah MS, Zealley IA, Mountain RE, Mahendran S. Severe benign hypopharynx/upper-oesophageal strictures: successful treatment with a novel interventional radiology technique in three patients. Clin Otolaryngol 2012; 37:313-7. [PMID: 22925097 DOI: 10.1111/j.1749-4486.2012.02496.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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16
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Gvalani AK, Deolekar S, Gandhi J, Dalvi A. Antesternal colonic interposition for corrosive esophageal stricture. Indian J Surg 2012; 76:56-60. [PMID: 24799785 DOI: 10.1007/s12262-012-0625-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Accepted: 06/12/2012] [Indexed: 10/28/2022] Open
Abstract
Restoration of swallowing in a patient with dysphagia due to nondilatable corrosive stricture of esophagus remains a surgical challenge. Organs available for replacement are stomach, jejunum, or colon. Jejunum is useful to replace a small segment, whereas stomach and colon are required for a long-segment replacement. In cases where the stomach is also injured, colon remains the only option. The route of colonic interposition has also been a subject of debate over the years. Antesternal, retrosternal, or esophageal bed passage are the routes described. In the present series, the data of antesternal colonic interposition (ACI) performed for nondilatable benign esophageal strictures in 32 patients (1988-2011) have been retrospectively analyzed. The results indicate that ACI for corrosive strictures is a quick and simple procedure. Thoracotomy is avoided and anastomosis is easily performed in the neck, and mortality rate due to anastomotic failure or graft failure is diminished. This retrospective analysis discusses the ease, effectiveness, quality of life, morbidity, and mortality of ACI and compares the pros and cons of ACI with other procedures described in the literature.
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Affiliation(s)
- Anil Kumar Gvalani
- Department of General Surgery, Seth GS Medical College & K E M Hospital, Parel, Mumbai, 400012 India
| | - Samir Deolekar
- Department of General Surgery, Seth GS Medical College & K E M Hospital, Parel, Mumbai, 400012 India
| | - Jignesh Gandhi
- Department of General Surgery, Seth GS Medical College & K E M Hospital, Parel, Mumbai, 400012 India
| | - Abhay Dalvi
- Department of General Surgery, Seth GS Medical College & K E M Hospital, Parel, Mumbai, 400012 India
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Lachaux A, Mas E, Breton A, Barange K, Heresbach D, Molard BR. Consensus en endoscopie digestive : prise en charge des œsophagites caustiques. ACTA ACUST UNITED AC 2011. [DOI: 10.1007/s10190-011-0191-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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18
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[Redundant coloplasty as a cause of a persistent cervical fistula]. Cir Esp 2011; 90:270-2. [PMID: 21616482 DOI: 10.1016/j.ciresp.2011.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Revised: 04/05/2011] [Accepted: 04/06/2011] [Indexed: 11/24/2022]
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Lefrancois M, Gaujoux S, Resche-Rigon M, Chirica M, Munoz-Bongrand N, Sarfati E, Cattan P. Oesophagogastrectomy and pancreatoduodenectomy for caustic injury. Br J Surg 2011; 98:983-90. [DOI: 10.1002/bjs.7479] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2011] [Indexed: 01/21/2023]
Abstract
Abstract
Background
The justification for pancreatoduodenectomy (PD) for extended duodenal and pancreatic caustic necrosis is still a matter of debate.
Methods
This was a retrospective evaluation of patients who underwent PD in association with oesophagogastrectomy from a large single-centre cohort of patients with caustic injuries. Morbidity, mortality and long-term outcome were assessed.
Results
PD was performed in 18 (6·6 per cent) of 273 patients who underwent emergency surgery for caustic injuries. Biliary and pancreatic duct reconstruction during PD was performed in ten and six patients respectively. Seven patients died and 17 experienced operative complications after PD for caustic injuries. Twelve patients required at least one reoperation. Specific PD-related complications occurred in 13 patients. Initial (P = 0·038) or secondary (P < 0·001) extension of necrosis to adjacent organs were independent predictors of operative death. After a median follow-up of 24 months following reconstruction, three patients had recovered nutritional autonomy. In an intention-to-treat analysis, functional success was recorded in three patients and the 5-year survival rate was 39 per cent after PD for caustic injury.
Conclusion
PD can save the lives of patients with caustic injuries extending beyond the pylorus, but has poor functional outcome. Immediate pancreatic duct reconstruction should be preferred to duct occlusion to decrease the rate of pancreatic complications.
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Affiliation(s)
- M Lefrancois
- Department of Digestive Surgery, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), and University Paris 7, France
| | - S Gaujoux
- Department of Digestive Surgery, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), and University Paris 7, France
| | - M Resche-Rigon
- Department of Biostatistics, Hôpital Saint-Louis, AP-HP, and Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - M Chirica
- Department of Digestive Surgery, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), and University Paris 7, France
| | - N Munoz-Bongrand
- Department of Digestive Surgery, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), and University Paris 7, France
| | - E Sarfati
- Department of Digestive Surgery, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), and University Paris 7, France
| | - P Cattan
- Department of Digestive Surgery, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), and University Paris 7, France
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Moussi A, Daldoul S, Gherib BS, Zaouche A. Surgical treatment of late dysfunction of an esophagocoloplasty. J Visc Surg 2010; 147:e395-8. [PMID: 20880770 DOI: 10.1016/j.jviscsurg.2010.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Replacement of the esophagus by colon interposition often has late complications, frequently due to technical defects. We report the case of a patient who presented 12 years after surgery with complex dysfunctions of a colonic interposition, including cervical and retrosternal strictures associated with a redundant portion of the colon graft. The interest of this case lies in its combination of many late complications of this surgery in a single person together with the simplicity of the treatment.
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Affiliation(s)
- A Moussi
- Service de chirurgie générale A, hôpital Charles-Nicolle, boulevard 9-Avril-1938, 1006 Tunis, Tunisia.
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Munoz-Bongrand N, Chirica M, Sarfati E. Coloplastie transverse gauche après œsogastrectomie totale. ACTA ACUST UNITED AC 2009; 146:559-64. [DOI: 10.1016/j.jchir.2009.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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