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Tracheal Compression by the Stomach Following Gastric Pull-Up*: Diagnosis With CT and Treatment With Expandable Metallic Stent Placement

Suil Kim, MD, PhD; Michael B. Gotway, MD; W. Richard Webb, MD; Roy L. Gordon, MD; Jeffrey A. Golden, MD
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*From the Departments of Medicine (Drs. Kim and Golden) and Radiology (Drs. Gotway and Webb), Division of Pulmonary and Critical Care Medicine, and the Section of Interventional Radiology (Dr. Gordon), University of California, San Francisco, CA.

Correspondence to: Jeffrey A. Golden, MD, Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, 400 Parnassus Ave, Box 0359, San Francisco, CA 94143-0359; e-mail: jgolden@itsa.ucsf.edu



Chest. 2002;121(3):998-1001. doi:10.1378/chest.121.3.998
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Surgical treatment of recurrent achalasia includes esophagectomy with gastric pull-up. A MEDLINE search yielded no articles describing an adverse effect of this surgery on pulmonary function. We report the first case of acute ventilatory failure caused by gastric pull-up. An evaluation by flexible bronchoscopy, spirometry with flow-volume loops, and dynamic CT scanning revealed extrinsic compression of the trachea by the stomach causing obstruction. Endotracheal placement of a self- expanding stent resulted in the rapid extubation of the patient with normalization of the flow-volume loop and dramatic improvement in the FVC, FEV1, and peak expiratory flow.

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