Primary aortoesophageal fistula from metallic bristle ingestion

Although many patients are treated for the removal of ingested foreign objects each year, ingestions that perforate the esophagus and lead to intra-abdominal complications are rare. Aortoesophageal fistulas and aortic pseudoaneurysms are deadly complications of esophageal foreign body impaction. However, the surgical approach to aortic repair from foreign object damage has not been standardized. We have described the diagnostic, open surgical, and therapeutic approach to treating a man who had accidentally ingested a 3-cm metallic bristle that lodged in his aortic wall. The patient recovered after excision of the aortic pseudoaneurysm with CryoGraft (CryoLife, Inc, Kennesaw, Ga) replacement, drainage of abscesses, and antibiotic treatment for multiple infections

Stronger but Not Faster : Flipped Classroom Teaching Significantly Improves Resident\u27s Skills but Not Speed

Objective: Flipped classroom teaching is a nontraditional education model where instructional content is delivered outside the classroom. This constructivist approach emphasizes self-direction, active inquiry; the instructor’s role is to foster critical reflection and facilitate the application and understanding of concepts. Our objective was to study the difference in time taken and quality of patch graft angioplasty performed by residents with and without flipped teaching. Methods: The study was set in a skills simulation teaching session overseen by attending surgeons. The intervention consisted of introducing a video outlining the technical aspects of patch graft angioplasty, watched before the session. The first group (2018 postgraduate year [PGY] 1 and 2 residents) was given instructions at the time of the class without a prior educational video or resources (Figs 1 and 2). The second group (2019, 2020 PGY 1 and 2 residents) was asked to watch a 20-minute video on the technical aspects of the procedure before the class. Participants then performed a standardized patch graft closure of a 1 cm arteriotomy using a polytetrafluoroethylene patch. The groups were timed. The quality of the closure was tested by assessing the number of leaks and the quantity of leak of the patch (Fig 3). Bivariate analysis sample t-tests were used for statistical analysis. P value \u3c.05 was considered significant. Pre- and post-session surveys were conducted to assess residents’ experience. Results: Forty-two residents (PGY 1 and 2) were enrolled in the study, 15 in nonintervention group 1 and 27 in intervention group 2, compared with 7 staff vascular surgeons. The mean completion time was 26 minutes (group 1) vs 27 minutes (group 2), P ¼ .6. The staff completion time was 12 minutes, P ¼ .001. The number of major leaks (not needle holes) was 2.0 (group 1) vs 1.6 (group 2), P ¼ .007, none for staff. The total quantity of leak was 42 mL (group 1) vs 15 mL (group 2), P ¼ .0001 (Table I). There was perceived improvement in skill on analyzing pre- and post-session surveys (Table II). Conclusions: A structured educational intervention, watching a video of a procedure before the skills session, did not change the time needed to complete the skill. There was improvement in the technical outcome of the procedure defined by a decrease in the total quantity of leak. Reversed classroom teaching significantly improves resident’s skill, not speed. There was also a perceived improvement in skill by participants. This is a pilot study and further instructional outcomes are being studied

Aortic pseudoaneurysm - An unusual presentation

Introduction: The esophagus is a frequent site of foreign body impaction, but esophageal perforation and subsequent aortic pseudoaneurysms, and aorto-esophageal fistulas are very rare but potentially life-threatening complications. We present a case of foreign body ingestion, complicated by erosion into the aorta causing a mycotic aneurysm. Case description: We introduce the case of a 60 year-old male with abdominal pain, nausea, fatigue and fevers. Blood cultures grew out gram-positive cocci. A CT scan revealed a distal thoracic aortic saccular aneurysm, with a 2.8 cm linear metallic body penetrating the inferior border of the aneurysm, and intraluminal thrombus formation. CT of the abdomen revealed portal vein thrombosis, splenic and hepatic abscesses. An Esophagogastroduodenoscopy was unremarkable. The patient was started on the appropriate antibiotic therapy. He was then taken to the operating room for an open thoracoabdominal aortic aneurysm repair with an interposition cryopreserved graft, with an intercostal muscle flap. A metal bristle was removed. He had an uneventful postoperative course and was discharged home on post-operative day 17. Follow-up CTA showed resolution of the infection and satisfactory repair. Post-operative esophagram showed no esophageal injury. Conclusion: We describe a case of a bristle from a metallic barbeque brush that was ingested. This penetrated the esophagus causing a mycotic aneurysm with septic embolization to the spleen and liver. Our successful treatment approach involved open aortic repair with an interposition cryopreserved graft, and an intercostal muscle flap.https://scholarlycommons.henryford.com/merf2020caserpt/1100/thumbnail.jp

Mycotic Aneurysm After Metallic Foreign Body Ingestion

Objective: The esophagus is a frequent foreign body impaction site. We present a case of foreign body ingestion complicated by erosion into the aorta, causing a mycotic aneurysm. Methods: We introduce the case of a 60-year-old man with abdominal pain, nausea, fatigue, and fevers. Blood cultures grew out gram-positive cocci. A computed tomography (CT) scan revealed a distal thoracic aortic saccular aneurysm, with a 2.8-cm linear metallic body penetrating the inferior border of the aneurysm, and intraluminal thrombus formation (Fig, A). CT of the abdomen revealed portal vein thrombosis and splenic and hepatic abscesses. Esophagogastroduodenoscopy was unremarkable. Results: The patient was started on the appropriate antibiotic therapy. He was then taken to the operating room for an open thoracoabdominal aortic aneurysm repair with an interposition cryopreserved graft, with an intercostal muscle flap (Fig, B). A metal bristle was removed (Fig, C). He had an uneventful postoperative course and was discharged home on postoperative day 17. Follow-up CT angiography showed resolution of the infection and satisfactory repair (Fig, D). Postoperative esophagram showed no esophageal injury. Conclusions: We describe a case of a bristle from a metallic barbecue brush that was ingested. This penetrated the esophagus, causing a mycotic aneurysm with septic embolization to the spleen and liver. Our successful treatment approach involved open aortic repair with an interposition cryopreserved graft and an intercostal muscle flap