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J Thorac Cardiovasc Surg 2007;134:805-807
© 2007 The American Association for Thoracic Surgery

Brief Communication

Staged closure of tracheogastrocutaneous fistula after esophagectomy for infiltrative granular cell tumor

^a Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
^b Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.

Received for publication February 28, 2007; revisions received May 14, 2007; accepted for publication May 23, 2007.

^_* Address for reprints: Henning A. Gaissert, MD, Massachusetts General Hospital, Blake 1570, Fruit St, Boston, MA 02114. (Email: hgaissert@partners.org).

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

We report a tracheogastrocutaneous fistula and bilateral vocal cord paralysis after resection of an esophageal tumor. Reconstruction in 2 stages restored voice and swallowing.

Clinical Summary

A 22-year-old woman with a normal voice presented with a 3-year history of progressive dysphagia to solids and choking. A computed tomographic scan (Figure 1) showed a 3.8 x 1.7–cm esophageal wall mass compressing the trachea. A submucosal mass was found on endoscopy; biopsy was nondiagnostic. A cervical incisional biopsy specimen was interpreted as a benign granular cell tumor (GCT). The patient sought a second opinion and underwent neck re-exploration with tracheostomy. A second biopsy specimen was read as a malignant GCT. The mass was resected during a third procedure by dividing the trachea to provide access for total esophagectomy and posterior window resection of the trachea. After esophageal anastomosis in the neck to stomach, the cartilaginous trachea was closed and tracheal continuity was restored. The patient awoke hoarse from the operation. One week later, a fistula presented between the trachea and esophageal anastomosis.

View larger version (97K):   Figure 1. Computed tomographic scan demonstrates . . . [Full Text of this Article]