BSUGIS Spring Meeting March 18, 2014

Lieven Depypere, Willy Coosemans, Georges Decker, Hans Van Veer, Philippe Nafteux

Department of thoracic surgery, University Hospitals Leuven, Belgium

2nd Interactive Case

BSUGIS Spring Meeting March 18, 2014

Male, 79 y

Medical History:• Arterial hypertension• Hiatus hernia with short segment Barrett• Cervical laminoforaminotomt C7-Th1 right.

• Brother died from pancreatic cancer

BSUGIS Spring Meeting March 18, 2014

Clinical presentation:• ASA 2, 177cm, 106kg• August 2014: dysphagia for solid food

Work up:• Diagnosis of EG-juction carcinoma cT3N1M0,

adeno with signet cell differentiation• (upper GI endoscopy, endoscopic US with

punction of lymph node, CT thorax/abdomen, FDG-PET)

BSUGIS Spring Meeting March 18, 2014

PETCT

BSUGIS Spring Meeting March 18, 2014

Q2.1 Would you do a staging laparoscopy as part of the diagnostic work-up?

• Yes• Yes, with insertion of a feeding jejunostomy• No

BSUGIS Spring Meeting March 18, 2014

• The patient was sheduled for neo-adjuvant therapy

BSUGIS Spring Meeting March 18, 2014

Q2.2 what neo-adjuvant therapy?

• Chemotherapy• Chemoradiotherapy

BSUGIS Spring Meeting March 18, 2014

Q2.3 functional assessment

• Before neo-adjuvant therapy• After neo-adjuvant therapy• Before and after neo-adjuvant therapy

BSUGIS Spring Meeting March 18, 2014

• Shortly after start of TPN: fever

with diagnosis of catheter sepsis with acineto-bacter sp, staphylococcus epidermidis, capitis and schleiferi. CVL was removed, vancomycine-piperacilline-tazobactam started and nasoduodenal feeding tube placed. • After 3 weeks vancomycine-piperacilline

Tazobactam: still fever:• Blood culture negative, urine culture negative,

BAL: candica, rare

BSUGIS Spring Meeting March 18, 2014

Transthoracic heart ultrasound: • adjacent structure on the aortic valve

without hemodynamic problems: endocarditis?

BSUGIS Spring Meeting March 18, 2014

Q2.5 Next step?

• Antibiotics further• Stop antibiotics and start eventually after

new cultures• Switch antibiotics• Cardiac surgery

BSUGIS Spring Meeting March 18, 2014

…curious about the evolution?

Register here !