Published online Mar 21, 2015. doi: 10.3748/wjg.v21.i11.3394
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.
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.