Tracheomalacia as a Complication of Stenting for Esophageal Injury after a Transsternal Approach to High Thoracic Vertebral Metastasis.

Tracheomalacia as a Complication of Stenting for Esophageal Injury after a Transsternal Approach to High Thoracic Vertebral Metastasis.

World Neurosurg. 2019 Feb 02;:

Authors: Chung KC, Lin CH, Tsai CL, Li YH, Liao CH

Abstract
BACKGROUND: and Importance: Esophageal injury is a severe surgical complication of a transsternal approach to the high thoracic vertebral metastasis, which can result in mediastinitis and life-threatening consequences. A covered stent can be placed in the esophagus to prevent mediastinal leakage. However, tracheomalacia is a very rare complication following esophageal stenting.
CLINICAL PRESENTATION: A 56-year-old man had a pathologic fracture of the T3 vertebral body with spinal cord compression, myelopathy, and neurogenic bladder. An esophageal injury was noticed during the transsternal approach. Immediate suture repair, drainage tube placement, and subsequent esophageal stenting were carried out. One month after discharge, the endoscopic examination revealed non-healing of the esophagus, and a new covered stent was replaced. Episodes of severe stridor and dyspnea made him sent to the emergent department. CT scan of the chest revealed a focal collapse of the trachea at the thoracic inlet, and tracheomalacia was suspected. The covered stent was removed, despite non-healing of the esophagus. His stridor, dyspnea, and constant coughing subsided afterwards. The endoscopic examination at three-months after stent removal showed complete healing of the esophagus.
CONCLUSION: Esophageal stenting can be used to prevent mediastinal leakage due to esophageal injury in the transsternal approach for high thoracic vertebral metastasis, but the stent might be a cause of tracheomalacia. Stent removal should be considered if upper airway obstruction occurs. Awareness of the radial force of the stent, esophageal composition (e.g. status post suture repair), and esophageal diameter must be considered for optimal stent tolerance to avoid complications.

PMID: 30721772 [PubMed - as supplied by publisher]

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