A case of a gastrobronchial fistula after esophageal reconstruction successfully closed with an intercostal muscle flap

Abstract

A case of a gastrobronchial fi stula after esophageal reconstruction successfully closed with an intercostal muscle fl ap Abstract A 63-year-old man with esophageal cancer underwent a subtotal esophagectomy via the thoracolaparotomy approach. Two years after the operation, a gastrobronchial fi stula unexpectedly occurred in the right bronchus. After admission, medication including omeprazole and nutritional support administered through an enteral tube improved his general condition, and the gastrobronchial fi stula was successfully closed with the seventh intercostal muscle fl ap. After the operation, sputa were aspirated with a bronchofi berscope through a tracheal incision rather than blindly with a catheter. He was in good condition 10 months after the operation.

Emergency escape surgery for a gastro-bronchial fistula with respiratory failure that developed after esophagectomy

“…The various reported causes of GBF are anastomotic leakage [ 3 , 7 ], necrosis of the gastric tube [ 7 ], peptic ulcers [ 8 ], bronchial ischemia [ 9 ] and radiation [ 9 ]. We considered that the direct cause of the GBF in our case was the gastric tube ulcer in the present patient.…”

“…Surgical treatment generally consists of a direct approach with dissection of the fistula and closure of the tracheal and gastric tube defects [ 14 , 15 ]. In addition, some authors have described using interposed vital tissue (diaphragm, pericardial or muscle-flaps) [ 1 , 7 , 8 , 16 – 18 ] to fill dead space, protect the fistula between the bronchus and gastric tube and possibly to help prevent fistulae from recurring.…”