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Jatrogenne przetoki przełyku po zabiegach chirurgicznych w obrębie szyi

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Kowalik K., Gruszczyńska A., Kowalska A., Pękala M., Modrzejewski A.
Polski Przegląd Otorynolaryngologiczny
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2023
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vol. 12
|
issue 2
70-75
PL
Wstęp: Jatrogenne przetoki przełyku po operacjach w obrębie szyi są rzadko omawianym tematem w polskim piśmiennictwie. Ze względu na nieliczne publikacje na temat przetok przełyku, perforacji przełyku po operacjach w obrębie szyi podjęto temat pracy. W tym celu dokonano przeglądu piśmiennictwa oraz przedstawiono opis dwóch przypadków, porównując napotkane trudności diagnostyczno-terapeutyczne do literatury światowej. Opisy przypadków: W prezentowanych przypadkach, po operacjach w obrębie szyi, doszło do powstania przetoki przełyku. W 1. przypadku przetoka przełyku była powikłaniem po wycięciu uchyłka Zenkera, a w 2. przetoka powstała po usunięciu tarczycy. Przetoki przełyku u opisywanych chorych okazały się dużym wyzwaniem terapeutycznym. Pomimo podejmowania u obu pacjentów szeregu zabiegów naprawczych – przeprowadzanych przez chirurgów, laryngologów i torakochirurgów – nie osiągnięto pełnego sukcesu terapeutycznego. W niniejszej pracy autorzy odnieśli sposoby postępowania u prezentowanych chorych do doświadczeń innych ośrodków. Omówiono metody leczenia przetok przełyku, możliwe powikłania oraz sposoby leczenia tych powikłań.
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Iatrogenic oesophageal fistulas after neck region surgery

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Kowalik K., Gruszczyńska A., Kowalska A., Pękala M., Modrzejewski A.
Polski Przegląd Otorynolaryngologiczny
|
2023
|
vol. 12
|
issue 2
70-75
EN
Introduction: Iatrogenic esophageal fistulas after neck surgery are a rarely discussed topic in the Polish literature. Due to the scarcity of publications on esophageal fistulas, esophageal perforation after neck surgery, the topic of this paper was undertaken. For this purpose, the literature was reviewed and a description of two cases was presented, comparing the diagnostic and therapeutic difficulties encountered to the world literature. Case reports: In the cases presented, esophageal fistula formation occurred after operations in the neck. In the first case, the esophageal fistula was a complication after resection of Zenker’s diverticulum and in the second case, the fistula developed after removal of the thyroid gland. Esophageal fistulas in the described patients proved to be a major therapeutic challenge. Despite a number of repair procedures undertaken by surgeons, laryngologists and thoracic surgeons in both patients, full therapeutic success was not achieved. In the present study, the authors related the management modalities of the presented patients to the experience of other centers. Methods of treating esophageal fistulas, possible complications and ways of treating these complications are discussed.
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Non-metallic foreign bodies – diagnostic and therapeutic difficulties

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Kowalik K., Gruszczyńska A., Knychalska K., Kaźmierczak K., Modrzejewski A.
Polish Journal of Surgery
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2023
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vol. 96
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issue 6
47-51
EN
Introduction: The management of wounds with possible presence of a foreign body can pose major problems, especially for bodies that cannot be seen in X-ray scans. The most common materials of this type include wood and glass. The size of the foreign body is also important. If overlooked and left behind, even the smallest foreign body may result in permanent damage to local tissues or contribute to a systemic infection such as sepsis. The presence of a foreign body is not detected upon primary wound management in one-third of patients. Presented herein are the cases of four patients in whom foreign bodies in the form of splintered wood or glass shards were left in the wound following trauma, leading to significant difficulties in the diagnostics and removal of these foreign bodies. Aim: The aim of this study was to present four cases of patients presenting with non-metallic foreign bodies causing diagnostic difficulties due to the absence of shading components, and leading to complications such as purulent inflammation. Materials and methods: The study material was collected from the records of the Department of Forensic Medicine of the Pomeranian Medical University in Szczecin. Forensic medical opinions and medical records of the patients were analyzed. Results: Ultrasound and computed tomography (CT) scanning are promising methods for pinpointing the presence of foreign bodies such as splinters of wood and shards of glass within wounds. When left behind, a foreign body may lead to generalized inflammation and/or sepsis. Incomplete removal of the foreign body can result in chronic inflammatory reactions and consequent limb dysfunction. Discussion: The management of non-metallic foreign bodies in daily medical practice is discussed, and the reader is familiarized with the possible complications of a foreign body being left behind within the wounded tissue.
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