Fístula aortoesofágica en paciente con tubo de derivación salival de Montgomery

doi:10.1016/S0001-6519(08)73255-2

Acta Otorrinolaringológica Española

Volume 59, Issue 1, January 2008, Pages 39-40

https://doi.org/10.1016/S0001-6519(08)73255-2 Get rights and content

Las fístulas aortoesofágicas son afecciones sobradamente descritas y con múltiples etiologías. No obstante, es excepcional que se presenten por la utilización del tubo de derivación salival de Montgomery (TBSM), algo descrito en la literatura médica en una sola ocasión. Presentamos el caso clínico correspondiente a un paciente de 81 años que portaba un TBSM y falleció por una hemorragia masiva del tracto digestivo superior causada por una fístula aortoesofágica en la localización del TBSM. Se revisa la literatura sobre este tema.

Aorto-oesophageal fistula is a well-reported pathology with several known causes. The co-existence of this pathology associated with the use of a Montgomery salivary bypass tube (MSBT) is exceptional and only one case is described in the literature. We present here a case report about an 81-year-old patient with an MSBT who died because of a massive upper gastrointestinal bleeding caused by an aortooesophageal fistula at the site of the MSBT. The literature on this pathology will also be reviewed.

Section snippets

DISCUSIÓN

Las fístulas aortoesofágicas son entidades sobradamente conocidas que pueden tener múltiples causas. Las más habituales son: las anomalías congénitas, la ingestión de cuerpos extraños, los traumatismos, la cirugía esofágica, así como las iatrogénicas tanto por esofagoscopias como por utilización prolongada de sondas nasogástricas¹.

El tubo de TBSM es un recurso técnico que se utiliza en pacientes que presentan una fístula faringocutánea tras una laringectomía total o una faringolaringectomía,

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There are more references available in the full text version of this article.

Cited by (4)

Utility of the Montgomery salivary tubes for preventing pharyngocutaneous fistula in total laryngectomy
2020, American Journal of Otolaryngology - Head and Neck Medicine and Surgery
Citation Excerpt :
With regard to medical complications, the study by Kamhieh et al. [27] reports 4 distal migrations without noticeable consequences, and the authors remarked that, in order to avoid them, they usually suture the MSBT to an NGT that is fixed to the nasal septum. Nevertheless, a few complications have been reported, with fatal consequences in some of them: retro-œsophageal subclavian artery rupture [30]; death from aorto-œsophageal fistula [31,32]; migrations to the stomach in pharyngeal reconstructions with anterolateral thigh flap (the authors recommend suturing the MSBT to an NGT) [13]; digestive distal migration that concluded with the death of the patient due to intestinal obstruction with subsequent perforation [33]; aorto-œsophageal fistula in a pædiatric patient whose œsophageal atresia was reconstructed using an MSBT for a long period [31]. In summary, all research studies published to date have had important biases in their presenting few cases, being quite heterogeneous, involving inconclusive analyses, and selecting high-risk patients many of them with flap reconstructions.
To evaluate the prophylactic, protocolized, and standardized use of a Montgomery tube in preventing pharyngocutaneous fistulas after total laryngectomy and neck dissection.
Retrospective cohort study.
Tertiary referral centre.
A Montgomery salivary bypass tube was placed in 44 patients undergoing total laryngectomy and neck dissection, observing the percentage of fistula appearance and the time of start of deglutition. Comparison was made with a group of 28 patients prior to the implantation of the protocol in whom the tube was not used.
There was a statistically significant decrease in the percentage of fistulas and an earlier onset of deglutition in the salivary bypass tube patients compared to those in whom the tube had not been used.
Prophylactic and standardized use of the Montgomery salivary bypass tube in patients undergoing total laryngectomy and neck dissection might decrease the incidence of pharyngocutaneous fistula and improve the course of one that is already established.
Digestive migration and spontaneous expulsion of a Montgomery salivar derivation tube
2019, Acta Otorrinolaringologica Espanola
Do salivary bypass tubes lower the incidence of pharyngocutaneous fistula following total laryngectomy? A retrospective analysis of predictive factors using multivariate analysis
2017, European Archives of Oto-Rhino-Laryngology
Stent migration to the ileum-A potentially lethal complication after montgomery salivary bypass tube placement for hypopharyngeal stenosis after laryngectomy
2012, Head and Neck

^☆: Los autores no manifiestan ningún conflicto de intereses.

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CASOS CLÍNICOSFístula aortoesofágica en paciente con tubo de derivación salival de MontgomeryAorto-Oesophageal Fistula in Patient With Montgomery Salivary Bypass Tube☆

Section snippets

DISCUSIÓN

J Pediatric Surgery

Acta Otorrinolaringol Esp

J Pediatric Surg

Salivary bypass tube

Ann Otol Rhinol Laryngol

Manual for use of Montgomery laryngeal, tracheal and esophageal prosteses

Ann Otol Rhinol Laryngol Suppl

CASOS CLÍNICOS
Fístula aortoesofágica en paciente con tubo de derivación salival de MontgomeryAorto-Oesophageal Fistula in Patient With Montgomery Salivary Bypass Tube☆