Abstract
BackgroundTreatment for tracheoesophageal fistula (TEF), a life-threatening complication after esophagectomy, is challenging.Case presentationA 75-year-old man with thoracic esophageal cancer underwent subtotal esophagectomy and gastric tube reconstruction through the post-mediastinal root after neoadjuvant chemotherapy. Owing to postoperative anastomotic leakage, an abscess formed at the anastomotic region. Sustained inflammation from the abscess caused refractory TEF between the esophagogastric anastomotic site and membrane of the trachea, and several conservative therapies for TEF failed. Hence, the patient underwent surgery including division of the fistula, direct suturing of the leakage sites, and reinforcement with the flap of the thymus pedicle. As a result, the abscess and TEF disappeared after surgery and the patient was immediately administered an oral diet and discharged home 103 days after initial surgery.ConclusionsAlthough pedicle flaps for the reinforcement of TEF are usually obtained from muscle or pericardium, these flaps need enough lengths to overcome moving distance. We are the first in the existing literature to have successfully treated TEF with surgical repair using a thymus flap located close to TEF. The thymus pedicle might be another candidate for the reinforcement flap in TEF.
Highlights
Treatment for tracheoesophageal fistula (TEF), a life-threatening complication after esophagectomy, is challenging.Case presentation: A 75-year-old man with thoracic esophageal cancer underwent subtotal esophagectomy and gastric tube reconstruction through the post-mediastinal root after neoadjuvant chemotherapy
Conclusions: pedicle flaps for the reinforcement of TEF are usually obtained from muscle or pericardium, these flaps need enough lengths to overcome moving distance
The thymus pedicle might be another candidate for the reinforcement flap in TEF
Summary
Management of a TEF requires great knowledge and skill. In this case, a life-threating complication was successfully treated with surgical repair using a thymus flap. The other co-authors collected the data and discussed the content of the manuscript. All authors read and approved the final manuscript. Ethics approval and consent to participate Written informed consent was obtained from the patient for publication of this case report and its accompanying images. Tracheobronchial fistula during the perioperative period of esophagectomy for esophageal cancer. Japanese classification of esophageal cancer, 11th edition: part II and III. Taniguchi D, Saeki H, Nakashima Y, Tsutsumi R, Nhisimura S, Kudou K, et al Development of fistula between esophagogastric anastomotic site and cartilage portion of trachea after subtotal esophagectomy for cervical esophageal cancer: a case report.
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