A Case of Delayed Anastomotic Leakage Occurring after Salvage Esophagectomy

Abstract

A 41-year-old man who had hypopharyngeal cancer (T4a, N2, M0, Stage ⅣA) and thoracic esophageal cancer (Mt, T2, N2, M0, Stage Ⅲ ) underwent definitive chemoradiotherapy, and attained complete remission. Eight months later, local recurrence and lymph node recurrence of esophageal cancer were detected, and lymph node recurrence of hypopharyngeal cancer also occurred. He received salvage esophagectomy, reconstruction using a gastric tube via subcutaneous route, and jejunostomy. Postoperative course was uneventful and he was discharged on the 26 th postoperative day. On the 58th day after the operation, he was diagnosed as having panperitonitis due to small bowel perforation at the inserting portion of a nutrition tube, and he underwent an emergency operation. He went into septic shock, and needed a large amount of noradrenaline during and after the operation. On the 7th day after the emergency operation he needed no noradrenaline and left the intensive care unit. On the 9th day after the emergency operation, leakage of esophagogastrostomy site occurred which was conservatively treated. He left our hospital on the 52nd day after the surgery. Possible causes of delayed anastomotic leakage might include definitive chemo radiotherapy to the upper area of the gastric tube and gastric tube ischemia resulting from peripheral circulatory disturbance due to severe septic shock and the long-term use of noradrenaline.