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J Thorac Cardiovasc Surg 2005;130:914-915
© 2005 The American Association for Thoracic Surgery

Brief Communication

Transhiatal gastrobronchial fistula: A case report

Thomas D. Person, MD a , Christopher B. Komanapalli, MD a , Hannan Chaugle, MD a , Mithran S. Sukumar, MD a , Brett Sheppard, MD b , Paul H. Schipper, MD a , *

a Division of Cardiothoracic Surgery, Oregon Health and Sciences University, Portland, Ore.
b Department of Surgery, Oregon Health and Sciences University, Portland, Ore.

Received for publication February 23, 2005; accepted for publication March 18, 2005.

* Address for reprints: Paul H. Schipper, MD, Oregon Health and Sciences University, Department of Surgery, Division of Cardiothoracic Surgery L353, 3181 SW Sam Jackson Park Rd, Portland OR 97201 (Email: schippep@ohsu.edu).

The first 20% of the full text of this article appears below.

We present a case of gastrobronchial fistula after laparoscopic Nissen fundoplication. Although a known complication of antireflux surgery, this is the first case reported occurring after laparoscopic Nissen fundoplication or fundoplication with an intra-abdominal wrap. All previously reported cases involved an initial open operation and an intrathoracic wrap either intentionally left or subsequently herniating into the chest.

Clinical Summary

A 46-year-old man came to the emergency department with hemoptysis. His symptoms began 5 days before admission, with a cough and shortness of breath that progressed to hemoptysis. History was significant for asthma, cigarette smoking, and a Nissen fundoplication 5 years previously. His admission hematocrit value was 18.7%, for which packed red cells were transfused. White blood cell count was 17,000, platelet count was 631,000, creatinine level was 1.3 mg/dL, international normalized ratio was 1.2, and partial thromboplastin time was 34.9 seconds. Soon after admission, his respiratory status decompensated, and he required emergency intubation. A chest radiograph showed mild bilateral infiltrates, and bronchoscopy showed nonbloody bilious secretions in the airways bilaterally. . . . [Full Text of this Article]






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