Reflux gastro-oesophagien sur oesophage court : diagnostic radiologique et traitement chirurgical

L’œsophage court est une réalité anatomique chez près de 7 % des patients référés pour chirurgie antireflux. L’examen radiologique baryté comportant des clichés pris en position debout est le meilleur moyen d’apprécier l’irréductibilité de la jonction œso-gastrique sous le diaphragme. La fundoplicature intrathoracique selon Nissen réalisée par thoracotomie gauche est la meilleure technique chirurgicale pour obtenir un contrôle permanent et durable du reflux du contenu gastrique dans la lumière d’un œsophage court. Certains détails d’ordre technique doivent être impérativement respectés pour éviter des complications chirurgicales graves

The unrealised potential of videofluoromanometry (VFM) in dysphagia work-up

The unrealised potential of videofluoromanometry (VFM) in dysphagia work-up. Objective: To compare the actual and potential use of Videofluoromanometry (VFM) in dysphagia work-up. Methodology: Qualitative paper based on (1) a review of literature in English and (2) experience-based opinion. Results: The history, rationale and technical aspects of VFM are described. VFM indications are reviewed. The present clinical use of VFM is compared to the clinical potential originally foreseen. Discussion: Several suggestions for achieving the unrealised potential of VFM are proposed based on personal experience with VFM. Conclusion: Later studies should focus on relative pressure values rather than absolute values. A relative physiological variable is proposed: the Pharyngo-Oesophageal Pressure Gradient (POPG). A family of diseases with specific "manometric signatures", should be determined and a POPG reading scale should be established accordingly. Once that has been done, subsequent studies should determine the best technical approach to recording the POPG. Eventually, POPG results should be compared to Modified Barium Swallow results in order to specify potential disease-specific VFM patterns

Tracheal laceration and tension pneumomediastinum of spontaneous favorable outcome.

The case of a 75-year-old women with probable tracheal laceration and tension pneumomediastinum after intubation is reported. A dramatic reduction of tracheal caliber was observed during fiberoptic bronchoscopy. Despite severe dyspnea, the patient healed with conservative measures. We conclude that aggressive surgical treatment for tracheal laceration is not always necessary

Optimal diagnosis of anastomotic colorectal leak by combination of conventional colonic enema and CT.

Post-operative complications of colorectal surgery occur not uncommonly. They have to be detected as early as possible, in order to reduce their morbidity and mortality rates. The most frequent early complications are abscesses, mechanical obstruction, and anastomotic leak. Imaging studies are required in order to assess such complications. We present a case for which radiological procedures were contributive for an optimal diagnosis of anastomotic leak following colo-rectal anastomosis. We emphasize the role of conventional radiology (contrast enema) combined with CT in the post-operative detection of an anastomotic intestinal leak