Esophageal perforation secondary to malignant gastric outlet obstruction: a case report

Background Esophageal perforation is a rare presenting sign of gastric cancer. To date, only nine case reports of this phenomenon have been previously published. Case presentation Esophageal perforation was diagnosed radiographically during workup for acute chest pain in a 67-year-old man. Emergent endoscopy confirmed esophageal perforation and biopsied a pre-pyloric mass confirmed to be adenocarcinoma. The perforation was managed with endoscopically placed transluminal pleural and mediastinal drains and esophageal stenting. The gastric outlet obstruction was temporized with a transpyloric stent. After the patient recovered from sepsis, distal gastrectomy was performed and he made a full recovery. Conclusions Rarely, pre-pyloric gastric cancer can present with Boerhaave syndrome, spontaneous esophageal perforation associated with forceful vomiting. We present the tenth report in the literature of this phenomenon and the first to be initially treated with endoscopic stenting and transluminal thoracoscopic drainage. When endoscopic management is used to treat patients with Boerhaave syndrome, it may be beneficial to examine the entire stomach to evaluate for malignant etiology

Fiducial marker placement with electromagnetic navigation bronchoscopy: a subgroup analysis of the prospective, multicenter NAVIGATE study

Fiducial markers (FMs) help direct stereotactic body radiation therapy (SBRT) and localization for surgical resection in lung cancer management. We report the safety, accuracy, and practice patterns of FM placement utilizing electromagnetic navigation bronchoscopy (ENB). Methods: NAVIGATE is a global, prospective, multicenter, observational cohort study of ENB using the superDimension™ navigation system. This prospectively collected subgroup analysis presents the patient demographics, procedural characteristics, and 1-month outcomes in patients undergoing ENB-guided FM placement. Follow up through 24 months is ongoing. Results: Two-hundred fifty-eight patients from 21 centers in the United States were included. General anesthesia was used in 68.2%. Lesion location was confirmed by radial endobronchial ultrasound in 34.5% of procedures. The median ENB procedure time was 31.0 min. Concurrent lung lesion biopsy was conducted in 82.6% (213/258) of patients. A mean of 2.2 ± 1.7 FMs (median 1.0 FMs) were placed per patient and 99.2% were accurately positioned based on subjective operator assessment. Follow-up imaging showed that 94.1% (239/254) of markers remained in place. The procedure-related pneumothorax rate was 5.4% (14/258) overall and 3.1% (8/258) grade ⩾ 2 based on the Common Terminology Criteria for Adverse Events scale. The procedure-related grade ⩾ 4 respiratory failure rate was 1.6% (4/258). There were no bronchopulmonary hemorrhages. Conclusion: ENB is an accurate and versatile tool to place FMs for SBRT and localization for surgical resection with low complication rates. The ability to perform a biopsy safely in the same procedure can also increase efficiency. The impact of practice pattern variations on therapeutic effectiveness requires further study

Pleural Dye Marking of Lung Nodules by Electromagnetic Navigation Bronchoscopy

IntroductionElectromagnetic navigation bronchoscopy (ENB)‐guided pleural dye marking is useful to localize small peripheral pulmonary nodules for sublobar resection.ObjectiveTo report findings on the use of ENB‐guided dye marking among participants in the NAVIGATE study.MethodsNAVIGATE is a prospective, multicentre, global and observational cohort study of ENB use in patients with lung lesions. The current subgroup report is a prespecified 1‐month interim analysis of ENB‐guided pleural dye marking in the NAVIGATE United States cohort.ResultsThe full United States cohort includes 1215 subjects from 29 sites (April 2015 to August 2016). Among those, 23 subjects (24 lesions) from seven sites underwent dye marking in preparation for surgical resection. ENB was conducted for dye marking alone in nine subjects while 14 underwent dye marking concurrent with lung lesion biopsy, lymph node biopsy and/or fiducial marker placement. The median nodule size was 10 mm (range 4‐22) and 83.3% were <20 mm in diameter. Most lesions (95.5%) were located in the peripheral third of the lung, at a median of 3.0 mm from the pleura. The median ENB‐specific procedure time was 11.5 minutes (range 4‐38). The median time from dye marking to resection was 0.5 hours (range 0.3‐24). Dye marking was adequate for surgical resection in 91.3%. Surgical biopsies were malignant in 75% (18/24).ConclusionIn this study, ENB‐guided dye marking to localize lung lesions for surgery was safe, accurate and versatile. More information is needed about surgical practice patterns and the utility of localization procedures.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/151973/1/crj13077_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/151973/2/crj13077.pd

Laparoscopic Peritoneopericardial Herniorrhaphy in 2 Dogs

Two peritoneopericardial hernias (PPDH) repaired laparoscopically are reported. Both PPDHs were approached with the dog in dorsal recumbency. Herniated organs (gallbladder and 2 liver lobes in Case 1 and omental fat in Case 2) were dissected and reduced. Hernias were closed in a 2-layer horizontal mattress pattern using 2-0 polyester (Case 1), and in a single-layer simple continuous pattern using 0 barbed polyglyconate (Case 2). Reduction and herniorrhaphy were achieved without conversion. Moderate to severe systemic hypotension was observed in both dogs which responded rapidly to reducing abdominal insufflation. Ten- and 7-month follow-up confirmed good clinical outcome in both dogs