Mineo Asaoka

[Combined rupture of trachea and esophagus following blunt trauma--a case report].

A 49-year-old man was involved in a motor vehicle crash and was admitted to a local hospital. The following day, he was transferred to our hospital because of worsening dyspnea. Initial examination revealed no subcutaneous emphysema, and chest computed tomography (CT) demonstrated no mediastinal air. A left thoracentesis tube was placed for pneumothorax, which reduced the patients respiratory distress. He had a persistent, productive cough, which worsened when he drank water. A repeat chest CT on the fifth hospital day revealed a tracheo-esophageal fistula. Bronchoscopy and esophagoscopy confirmed the diagnosis. He underwent repair of the trachea and esophagus. The ruptured membraneous portion of the trachea was closed with interrupted sutures and covered with pedicled pericardial flap. The perforated anterior esophageal wall was sutured in layers and reinforced with a fifth intercostal muscle flap. A gastrostomy tuve was placed for feeding access. Within 6 weeks, the patient recovered completely.

One stage repair for an oesophageal fistula after pneumonectomy using an omental pedicle flap.

A 67 year old man developed an oesophageal fistula after a pneumonectomy that was complicated by an empyema. An omental pedicle flap was brought through the diaphragm to repair the fistula and to fill the empyema space. The outcome was successful.

Combined Coronary Artery Re-Operation and Pulmonary Resection for Hemoptysis

We present a 59-year-old woman who underwent combined pulmonary resection for bronchiectasis with massive, recurrent hemoptysis and redo coronary artery bypass. She had previously been hospitalized four times for massive hemoptysis. She had also undergone coronary artery bypass and had symptomatic severe graft disease. We performed simultaneous right middle lobectomy and redo triple bypass. At surgery, lobectomy was performed before heparinization, then redo bypass was performed using on-pump cardiopulmonary bypass. The postoperative course was uneventful.