O-086 * LIFE-THREATENING COMPLICATION OF COLON INTERPOSITION AFTER OESOPHAGECTOMY
Bibliographic record
Abstract
Objectives: Fistula between intrathoracic conduit replacing an oesophagus and adjacent organs is a rare and challenging situation with high mortality rate. Case description: We present a 47-year old woman with congenital oesophageal atresia. During childhood she underwent several operations, eventually with colon replacement of her oesophagus. Subsequently, she developed dysphagia and severe reflux that required two redo thoracotomies and a laparotomy to revise her colo-gastric anastomosis and shorten a redundant colon conduit, with PEG insertion for nutritional supplementation. She presented with progressive weight loss, uncontrolled chest pain and massive upper gastrointestinal (GI) bleeding. A fistula was found between the left ventricle (LV) and the colonic conduit. She underwent urgent sternotomy, repair of LV pseudoaneurysm and colon-LV fistula using cardiopulmonary bypass and closure of defect in the colon by autologous pericardial patch. Pre and intraoperatively she required massive blood transfusions. In early postoperative period she developed leak from the intrathoracic colon to the pericardial space with associated pericarditis and mediastinitis. She required redo left thoracotomy, major decortication, debridement and attempted primary repair of complex defect in the colonic conduit with intercostal muscle buttressing. Few days later she developed sepsis and underwent re-do sternotomy and wide debridement. She remained with an open sternum. After achieving infection control and negative fluid balance re re-do thoracotomy and resection of the intrathoracic colon, proximal stomach and distal oesophagus was carried out, together with diverting cervical oesophagostomy. Subsequently she underwent delayed sternal closure. She had long recovery, but was eventually discharged with improvement of her nutritional status and no evidence of infection. One year after discharge she is alive and well, awaiting final reconstruction with a gastric conduit. Conclusions: Her case illustrates that prompt diagnosis and aggressive staged surgical treatment of LV to intrathoracic colon fistula may prevent an otherwise fatal outcome of this unusual problem. Disclosure: No significant relationships.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".