Morbidity meeting

1. MORBIDITY MEETING
(CaseReport)
Dr. Ali Mujtaba
(Resident Urology)
Department of Urology
SIUT , Karachi

2. Case no ESO-113/20
Age /sex 27 years / Male
Co morbid NKCM
D.O.A 10/8/20
D.O.S 11/08/20
Surgery Feeding Jejunostomy
Two stage Esoghagecotomy
Clavein-Dindo
Classification
Grade Illb

3. 27 years old male patient with NKCM was evaluated in GI OPD on 20/jan/20 for:
Dysphagia
Vomting for 2 months
Change of Voice
• After basic evaluation CT scan advised

4. CT-Scan Findings
• Circumferential heterogeneously enhanced mural thickness involving distal
esophagus and GEJ with local mass effects most likely “Adenocarcinoma”
• Biopsy advised for confirmation.

5. Eosophageal Growth Biopsy
• Well diff. Adenocarcinoma
• Feeding Jejunostomy done in Feb 2020
• CHEMO. Therapy: 5 cycles of FLOT completed in June 2020
• RADIO. Therapy: completed in June 2020

6. Post-Chemo CT scan
• Shows no significant change since previous study
• Then we planed “TWO STAGE ESOPHAGECTOMY”

7. • Patient admitted for
Two Stage (IVOR LEWIS) Esophagectomy on 10-aug-20
• Surgeons: Dr Shah Muhammad, Dr Shadab
• Scrubbed Residents: Dr Sarah, Dr Saba

8. HISTOPATHOLOGY
• Tumor is 4.5cm away from Proximal resection margin and 3cm away from distal
resection margin.
• Well diff. Adenocarcinoma
• Tumor invades muscularis propria
• No lymph node involved

9. Morbidity
• CHEST ISSUES:
PNEUMOTHORAX
PLEURAL EFFUSION
• ANASTOMOTIC LEAKAGE
On 5th POD Swallow test

11. Management
• For Chest Issues
1. Chest tube replacement + Suction
2. Chest Physio
3. ISM (Incentive spirometry)
4. Antibiotics

13. • Anastomotic leak
1. Conservatively
2. NPO
3. Feed via FJ
4. Repeat Swallow test on 14th POD shows still leakage
5. D/C with NPO and feeding via FJ

14. Follow Up
• 21st POD
• F/U in GI OPD
• No active chest issues
• Planed to check for anastomotic leak
• Swallow test not performed
• Orally feed started gradually

15. Second F/U
• FJ accidently removed
• Patient tolerating oral feed
• Advise to encourage oral feed
• FJ nor replaced