PERFORATION OF SMALL BOWEL IN AMYLOIDOSIS; INCLUDES REVIEW OF THE LITERATURE.
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We anesthetized a 69-year-old man with perforated necrotic trachea after radical esophageal cancer surgery. We recognized during the reoperation that necrotizing part of the trachea was perforated from the cricoid cartilage to 2cm above the carina. We ventilated the both lungs successfully without leaks by inserting a double-lumen tube into the trachea after tracheostomy. Postoperatively, the carina and the main bronchi were also necrotized and perforated. We ventilated the both lungs without leaks by inserting two single-lumen tubes into the left and right bronchi separately. But, eventually the distal part of the both bronchi was also necrotized and perforated. Finally, the patient died of respiratory failure due to hypoventilation on the 7th day after the re-operation. We should remember this type of emergency complication after radical esophageal cancer surgery.
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Between 1986 and 1994, 14 patients underwent emergency transhiatal oesophagectomy for iatrogenic instrumental perforation of the oesophagus. Continuity of the alimentary tract was restored immediately with cervical anastomosis by oesophagogastroplasty in 13 and oesophagocoloplasty in one. Six patients had oesophageal perforation with a carcinoma, seven had corrosive strictures, and cardiac achalasia was present in one. Only five patients underwent operation within 24 h of initial trauma. There were two postoperative deaths. Resectional surgery, though aggressive, has given good results for perforations with oesophageal strictures. Transhiatal subtotal oesophagectomy has both theoretical and practical advantages over transthoracic resection in the management of instrumental perforation with a distal stricture.
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