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Start Over Author "Miki Ishikawa" Journal surgical case reports
2 results on '"Miki Ishikawa"'

1. Inverse T-shaped sternotomy as novel thoracoplasty for severe chest deformation and tracheal stenosis

Author

Hirofumi Tomita, Akihiro Shimotakahara, Naoki Shimojima, Hideo Ishihama, Miki Ishikawa, Yuki Mizuno, Makoto Hashimoto, Ayano Tsukizaki, Kazuaki Miyaguni, and Seiichi Hirobe

Subjects
Severe motor and intellectual disabilities, Chest deformation, Tracheal stenosis, Brachiocephalic artery transection, Thoracoplasty, Surgery, RD1-811
Abstract

Abstract Background Patients with severe motor and intellectual disabilities often suffer from tracheal stenosis due to chest deformation and brachiocephalic artery compression, which sometimes leads to serious complications, such as dying spell and tracheobrachiocephalic artery fistula. We herein described our experience of performing a novel and simple thoracoplastic procedure combined with brachiocephalic artery transection in two patients with severe chest deformation and tracheal stenosis. Case presentation The patients were a 12-year-old female with cerebral palsy due to periventricular leukomalacia and a 21-year-old male with subacute sclerosing panencephalitis stage IV in the Jabbour classification following a laryngotracheal separation. Both patients showed severe chest deformation and symptoms of airway stenosis resulting in dying spells. The sternum was laterally transected between the manubrium and the sternal body, and a manubriotomy was performed longitudinally, ending with an inverse T-shaped sternotomy. Since the clavicle and the first rib remained attached to the halves of the divided manubrium, the sternum was allowed to be left open, resulting in improvement of the mediastinal narrowing and tracheal stenosis. Postoperative computed tomography (CT) showed that the distance between the halves of the manubrium was maintained at 10–11 mm, and that the mediastinal narrowing in both patients improved; the sternocervical spine distance increased from 20 mm to 22 and 13 mm to 16 mm, respectively. The patients’ tracheal stenosis below the sternal end of the clavicle and the manubrium and respiratory symptoms improved, and the patients are currently at home in a stable condition with no chest fragility and no upper limb movement disorder 1 year after surgery. Conclusions Our observations suggested that the inverse T-shaped sternotomy combined with brachiocephalic artery transection may relieve symptoms of tracheal stenosis due to severe chest deformation in patients with severe motor and intellectual disabilities.

Published
2021
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2. The use of a sternothyroid muscle flap to prevent the re-recurrence of a recurrent tracheoesophageal fistula found 10 years after the primary repair

Author

Miki Ishikawa, Takato Sasaki, Kouji Masumoto, Hajime Takayasu, and Kentaro Ono

Subjects
Sternothyroid muscle flap, Hiatus hernia, medicine.medical_specialty, medicine.medical_treatment, Fistula, Subglottic stenosis, Tracheoesophageal fistula, Case Report, 03 medical and health sciences, 0302 clinical medicine, Tracheotomy, Bronchoscopy, Recurrence, 030225 pediatrics, medicine, Hernia, Esophagus, medicine.diagnostic_test, business.industry, General surgery, medicine.disease, digestive system diseases, Surgery, Pneumonia, stomatognathic diseases, medicine.anatomical_structure, 030220 oncology & carcinogenesis, Esophageal atresia, business
Abstract

Recurrent tracheoesophageal fistula (TEF) is still difficult to diagnose and repair. In almost all cases, recurrence appears relatively soon after the primary surgery. We herein describe a case of recurrent TEF that appeared 10 years after the primary repair. At 2 years of age, the patient suffered from mental retardation due to encephalitis and developed a hiatus hernia with gastro-esophageal reflux. He underwent the repair of a hiatus hernia and fundoplication at 3 years of age. However, the hiatus hernia recurred 6 months after the operation. The patient suffered from recurrent pneumonia for 6 years after the appearance of the recurrent hiatus hernia. At 9 years of age, he was hospitalized frequently due to recurrent severe pneumonia. After admission at 9 years of age, an endoscopic study under general anesthesia was performed and revealed subglottic stenosis and a dilated esophagus with a recurrent hiatus hernia. Tracheotomy or laryngotracheal separation was first planned in order to improve his upper airway and facilitate the safer repair of the recurrent hiatus hernia. After laryngotracheal separation, the patient still suffered from severe pneumonia. In addition, a small volume of nutritional supplement was aspirated from the tracheostomy. Thus, recurrent TEF was suspected. Tests using dye under both esophagoscopy and bronchoscopy confirmed recurrent TEF. The fistula recurred in the cervical area because of the elevation of the esophagus due to the recurrent hiatus hernia. The fistula was surgically closed, with a sternothyroid muscle flap to prevent re-recurrence. At 4 months after this operation, the recurrent hiatus hernia was repaired. Thereafter, the patient’s respiratory symptoms showed a dramatic improvement. The patient is now doing well and free from further recurrences of TEF and hiatus hernia at 2 years after the final operation.

Published
2016

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