Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 21, 2015; 21(11): 3394-3401
Published online Mar 21, 2015. doi: 10.3748/wjg.v21.i11.3394
Bronchial bleeding caused by recurrent pneumonia after radical esophagectomy for esophageal cancer
Toshihiro Kitajima, Kota Momose, Seigi Lee, Shusuke Haruta, Masaki Ueno, Hisashi Shinohara, Sakashi Fujimori, Takeshi Fujii, Ryoji Takei, Tadasu Kohno, Harushi Udagawa
Toshihiro Kitajima, Kota Momose, Seigi Lee, Shusuke Haruta, Masaki Ueno, Hisashi Shinohara, Harushi Udagawa, Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo 105-8470, Japan
Sakashi Fujimori, Tadasu Kohno, Department of Thoracic Surgery, Toranomon Hospital, Tokyo 105-8470, Japan
Takeshi Fujii, Department of Pathology, Toranomon Hospital, Tokyo 105-8470, Japan
Ryoji Takei, Department of Radiology, Toranomon Hospital, Tokyo 105-8470, Japan
Author contributions: Kitajima T and Udagawa H designed the report; Momose K, Lee S, Haruta S, Shinohara H, Ueno M, Fujimori S and Kohno T were attending doctors for the patient and performed the operation; Takei R performed bronchial arterial embolization procedure; Fujii T performed the pathological examination; Kitajima T wrote this paper.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Toshihiro Kitajima, MD, Department of Gastroenterological Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minatoku, Tokyo 105-8470, Japan.
Telephone: +81-3-35881111 Fax: +81-3-35827068
Received: August 5, 2014
Peer-review started: August 6, 2014
First decision: August 27, 2014
Revised: September 8, 2014
Accepted: October 15, 2014
Article in press: October 15, 2014
Published online: March 21, 2015

We herein report a case of bronchial bleeding after radical esophagectomy that was treated with lobectomy. A 65-year-old male who underwent subtotal esophagectomy with three-field lymph node dissection for esophageal carcinoma was referred to our hospital because of sudden hemoptysis. After the esophagectomy, bilateral vocal cord paralysis was observed, and the patient suffered from repeated episodes of aspiration pneumonia. Bronchoscopy revealed hemosputum in the right middle lobe bronchus, and contrast-enhanced computed tomography showed tortuous arteries arising from the right inferior phrenic artery and left subclavian artery toward the right middle lobe bronchus. Although bronchial arterial embolization was performed twice to control the recurrent hemoptysis, the procedures were unsuccessful. Right middle lobectomy was therefore performed via video-assisted thoracic surgery. Engorged bronchial arterys with medial hypertrophy and overgrowth of the small branches were noted near the bronchus in the resected specimen. The patient recovered uneventfully and was discharged on postoperative day 14.

Keywords: Hemoptysis, Esophagectomy, Recurrent laryngeal nerve injury, Ectopic/collateral bronchial artery, Lobectomy, Aspiration pneumonia, Bronchial arterial embolization

Core tip: To the best of our knowledge, this is the first report of bronchial bleeding suspected to arise from ectopic/collateral bronchial arteries after radical esophagectomy with three-field lymphadenectomy for esophageal carcinoma. Such clinical course after esophagectomy for esophageal carcinoma is quite meaningful, especially in cases of postoperative recurrent aspiration pneumonia due to bilateral recurrent laryngeal nerve injury.