921 Cutaneo-Gastric Conduit Fistula Formation Following Oesophagectomy: A Rare Presentation of Anastomotic Leak

Abstract

Abstract Anastomotic leak is a significant contributor towards postoperative morbidity and mortality following oesophagectomy occurring between 5-30%. Clinical presentation as cutaneo-gastric conduit fistula is extremely rare as reported in the present study. A 60-year-old woman with previous right thoracotomy and lobectomy due to pneumonia underwent an Ivor Lewis oesophagectomy for a gastro-oesophageal junction adenocarcinoma. The operation was complicated by extensive adhesiolysis and 2.5L of blood loss requiring intra-operative transfusion. Postoperatively the patient developed acute respiratory distress syndrome (ARDS) from which she subsequently recovered. The integrity of the anastomosis was confirmed by oral contrast swallow and CT, after which the patient was discharged. Two weeks later, the patient was readmitted with right-sided chest pain and a swelling at the distal end of the thoracotomy scar. A purulent collection was identified and drained under interventional radiology. A repeat CT revealed the presence of a cutaneo-gastric conduit fistula originating from the anastomosis site. This was managed with endoscopic gluing of the gastric conduit wall defect and the application of a self-expanding metallic stent (SEMS) that was secured with an Apollo overstitch system to prevent migration. The patient was discharged with follow-up endoscopy confirming closure of defect. This report highlights the rare complication of cutaneo-gastric conduit fistula after oesophagectomy, associated risk factors and the successful management with SEMS application secured with Apollo overstitch.