Year 2017 Vol. 25 No 5

CASE REPORTS

S.N. YERMASHKEVICH1, M.M.KANDZERSKI2, V.I. PETUKHOV1, V.P.BULAUKIN1, M.I.KUHAYEU1, A.V.HARBUNOV2, S.G.BELAVUSAU2, M.O.RUSETSKAYA1, A.I.YANKOYSKI2, Y.S.PODOLINSKY2, M.V.KUNTSEVICH1

GASTRO-PULMONARY FISTULAS AT LEFT-SIDE TRAUMATIC DIAPHRAGMATIC HERNIA

EE “Vitebsk State Medical University” 1,
ME “Vitebsk Regional Clinical Hospital” 2, Vitebsk,
The Republic of Belarus

Gastro-pulmonary fistulas are extremely rare. The article describes a clinical case of the gastro-pulmonary fistulas complicating a left-side traumatic diaphragmatic hernia and resulted in the development the lower lobe gangrene of the left lung and sepsis.
41-year-old man 6 years after a penetrating stab injury to the left-side of the chest, cured by the tube thoracostomy, had pains in the left side of the lower part the chest and in the left hypochondrium, cough with expectoration of muco-purulent sputum streaked with blood, the body temperature increased up to 38°C. Chest X-ray, ultrasound and computed tomography of the abdomen showed subdiaphragmatic abscess and the destruction of the lower lobe of the left lung. After the puncture with the ultrasound-guided draining, the air vent was registered. The correct diagnosis was made 1,5 months after clinical onset of the disease as a result of a repeated magnetic resonance imaging. The patients underwent the anterolateral thoracotomy in the fifth intercostal space on the left-side with the resection of V ribs and the intersection of the left costal arch, uncoupling the gastro-pulmonary fistulas, the closure of the defect of the diaphragm, the lower lobectomy. The patient was discharged in a satisfactory condition 2 weeks after the surgery.
The analysis of the case and the literature review on the etiology, diagnosis and treatment of gastro-pulmonary fistulas are presented.

Keywords: diaphragm, stomach, lung, gastro-pulmonary fistula, traumatic diaphragmatic hernia, lung gangrene, sepsis
p. 525-534 of the original issue
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Address for correspondence:
210023, Republic of Belarus,
Vitebsk, Frunze Ave., 27,
EE “Vitebsk State Medical University”,
Department of Hospital Surgery
with Urology and Pediatric Surgery Courses,
tel. mob.: 375 29 731-55-16,
e-mail: ermashkevich_sn@tut.by,
Sergey N. Yrmashkevich
Information about the authors:
Yermashkevich S.N. PhD, Ass. Professor of Department of Hospital Surgery with Urology and Pediatric Surgery Courses, EE ‘’Vitebsk State Medical University’’.
Kandzerski N.M. Head of Thoracic Purulent Surgical Unit, ME ‘’Vitebsk Regional Clinical Hospital’’.
Petukhov V.I. MD, Head of Surgery Department of the Faculty of Advanced Training and Retraining, EE ‘’Vitebsk State Medical University’’.
Bulaukin V.P. PhD, Ass. Professor of the Surgery Department of the Faculty of Advanced Training and Retraining, EE ‘’Vitebsk State Medical University’’, Head of the Republican Scientific and Practical Center “Infection in Surgery”.
Kuhayeu M.I. PhD, Assistant of the Surgery Department of the Faculty of Advanced Training and Retraining, EE ‘’Vitebsk State Medical University’’.
Harbunov A.V. Deputy Chief Physician on Surgery, ME ‘’Vitebsk Regional Clinical Hospital’’.
Belavusau S.G. Surgeon of the Unit of Purulent Surgery, ME ‘’Vitebsk Regional Clinical Hospital’’.
Rusetskaya M.O. PhD, Ass. Professor of the Hospital Surgery Department with Urology and Pediatric Surgery Courses, EE ‘’Vitebsk State Medical University’’.
Yankoyski A.I. Surgeon of the Unit of Purulent Surgery of ME ‘’Vitebsk Regional Clinical Hospital’’.
Podolinsky Y.S. Surgeon of the Unit of Purulent Surgery, ME ‘’Vitebsk Regional Clinical Hospital’’.
Kuntsevich M.V. Post-Graduate Student of the Hospital Surgery Department with Urology and Pediatric Surgery Courses, EE ‘’Vitebsk State Medical University’’.
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