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DOI: 10.1055/s-0041-1727611
Endoluminal VAC (vacuum-assisted closure)- therapy for a radiogenically caused pharyngeal-prevertebral fistula
The endoluminal VAC-therapy is already used successfully in the management of upper gastrointestinal leaks and perforations. In the ENT area the use of VAC-therapy is known in pharyngocutanous fistulas. We now report on an application in a pharyngo-prevertebral fistula. The patient has had a panendoscopy with samplings from the hypopharynx because of a complex tumor history (State after laryngopharyngectomy and reconstruction with myofascial flap, State after radiochemotherapy) four weeks prior. He now reported about a pronounced odynophagia. At the examination, we discovered a lot of saliva in the hypopharyngeal funnel. A broad spectrum antibiotic therapy was started and a CT scan of the neck and a Gastrografin swallow was performed. The CT scan showed a defect in the right hypopharynx with an inflammatory fluid pathway emanating from it and extending dorsally to the prevertebral fascia. A contrast medium depot in the form of a hypopharyngeal right fistula was found in the swallow. Based on the findings we performed a panendoscopy and collected samples. Additionally we placed a gastric tube. During the surgery we saw a hypopharyngeal fistula on the right side into the carotid sheath reaching till prevertebral. The biopsy showed no malignancy. Due to the difficult soft tissue conditions without healing tendency under conservative therapy we decided to start an endoluminal retrogradely transnasally placed VAC-therapy as off-label use. Therefore we used the Eso-SPONGE®-system with a VAC-pump from the company KCI. The system was placed for 16 days, with regular changes every 4 days. Among this, a clear granulation of the fistula pocket with improvement of symptoms was observed. The system was tolerated without problems and oral nutrition was possible again afterwards.
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Der Erstautor gibt keinen Interessenskonflikt an.
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Publication History
Article published online:
13 May 2021
© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
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