Abstract
A 65-year-old man who had received an esophagectomy 10 years earlier was admitted to our hospital for right chest pain. Preoperative examinations showed pneumopericardium, a retrosternal gastric tube, and an active gastric tube ulcer. We diagnosed gastropericardial fistula of the gastric tube ulcer. Emergency surgery included lavage and drainage of the pericardial cavity and plombage of the rectus abdominis muscle flap to the posterior space of the gastric tube. Total parental nutrition and/or enteric nutrition were provided. Due to minor leakage from the ulcer, the patient could start oral intake on the postoperative 49th day, and was discharged from the hospital on the postoperative 86th day after physical rehabilitation. He has been free from complications for more than 33 months after surgery. Here, we review the literature and discuss the etiology and treatment of choice for this rare yet lethal complication in the follow-up after esophagectomy.
Highlights
Recent advances in thoracic surgery and post-surgical management in intensive care units (ICUs) have improved the survival of esophageal cancer patients after esophagectomy; many patients often survive more than five years
The stomach is the organ most used for reconstructions after an esophagectomy for esophageal cancer patients; in Japan, a retrosternal route is preferred, where the gastric tube is pulled up [6]
Recent advances in surgical procedures as well as ICU care have improved the postoperative prognosis of esophageal cancer patients, but longer post-surgical periods can lead to problems with gastric tubes, such as bleeding, perforated ulcers, or gastric tube cancers
Summary
Recent advances in thoracic surgery and post-surgical management in intensive care units (ICUs) have improved the survival of esophageal cancer patients after esophagectomy; many patients often survive more than five years. Post-operative CT showed the drainage tube in the pericardial space and a plombaged muscular flap between gastric tube and pericardium (Figure 3). On the 18th POD, gastrogram showed minor leakage from the gastric tube to the pericardium, but Figure 2 Pre-operative CT scans (A, B): arrows indicate pneumopericardium (A) or gastropericardial fistula (B); Preoperative upper GI endoscope shows the giant open ulcer within gastric tube, indicated by arrows (C). On the 76th POD, gastroendoscopy showed a healing (H1) ulcer in the gastric tube (40 cm from the incisors) (Figure 3B) He was discharged from the hospital on the 86th POD, after physical rehabilitation. Review of reported cases There are only two reports of a gastropericardial fistula of a gastric tube ulcer after esophagectomy [1,5]. [5] Current case surgical drainage is much better than that in conservative therapies or in percutaneous drainage
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