Aortoenteric fistula at the site of esophagojejunostomy after laparoscopic total gastrectomy: report of a case

Gunji, Shutaro; Okabe, Hiroshi; Obama, Kazutaka; Sakai, Yoshiharu

doi:10.1007/s00595-014-0834-3

Cited by 9 publications

(5 citation statements)

References 25 publications

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“…Overlap esophagojejunostomy has been reported to be a safe and useful technique in laparoscopic total gastrectomy [1–3, 8]. Gunji et al reported a case of AEF after laparoscopic total gastrectomy with overlap esophagojejunostomy for advanced gastric cancer with esophageal invasion [6]. In the reported case, bacterial peritonitis was diagnosed 5 days after the operation, manifesting as partial necrosis and perforation of the small intestine.…”

Section: Discussionmentioning

confidence: 96%

“…Noshiro stated that some extraverted esophageal and intestinal stumps in the thorax should be covered by suturing to prevent the formation of pulmonary fistulas, although AEF was not mentioned [5]. Gunji et al reported an AEF located above a triangular anastomosis between the esophagus, jejunal limb, and the descending aorta [6]. They speculated that the persistent contact of the staple line eroded the aortic wall, leading to AEF.…”

Section: Discussionmentioning

confidence: 99%

“…One rare report has detailed good postoperative outcomes of seven patients after esophagogastrectomy with radical lymphadenectomy in the lower mediastinum followed by overlap esophagojejunostomy [5]. Aortoenteric fistula (AEF) at the site of overlap esophagojejunostomy after laparoscopic total gastrectomy has been reported in the literature [6]. Herein, we report a case of AEF at the esophagojejunostomy site after laparoscopic esophagogastrectomy for cancer of the esophagogastric junction (EGJ), which is a rare, fatal complication involving the development of a fistula between the aorta and digestive tract.…”

Section: Introductionmentioning

confidence: 99%

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Aortoenteric fistula following overlap esophagojejunal anastomosis using linear staplers for cancer of the esophagogastric junction: a case report

Honda¹,

Sakamoto²,

Shoichi³

et al. 2019

surg case rep

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BackgroundAortoenteric fistula (AEF), occasionally reported as a fatal complication after aortic or other vascular procedures, is a communication between the aorta and the digestive tract. AEF as a fatal complication of overlap esophagojejunostomy after esophagogastrectomy has not been reported previously. Herein, we report a case of AEF after laparoscopic proximal gastrectomy and transhiatal lower esophagectomy for cancer of the esophagogastric junction, in which linear staplers were used for overlap esophagojejunostomy.Case presentationA 66-year-old woman with advanced cancer of the esophagogastric junction underwent laparoscopic proximal gastrectomy and transhiatal lower esophagectomy with abdominal and lower mediastinal lymphadenectomy. Double tract reconstruction by the overlap method was performed. The patient was discharged from the hospital 10 days after surgery with a good postoperative course. However, she developed sudden-onset massive hematemesis and melena the day after discharge, resulting in death. Autopsy revealed that the stapled edge of the entry hole of the overlap esophagojejunostomy was in direct contact with the descending aorta. AEF was found at the esophagojejunostomy site.ConclusionsTo our knowledge, this is the first report of AEF as a fatal complication of overlap esophagojejunostomy after esophagogastrectomy. Although we could not definitively identify the cause of the AEF, it could be attributed to direct contact between the stapled edge and the bare thoracic aorta over a period of 10 days. To avoid direct contact with the aorta in esophagojejunostomy with linear staplers, all stapled edges should be covered by suturing and attention should be paid to the position of these edges.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Aortoenteric fistula following overlap esophagojejunal anastomosis using linear staplers for cancer of the esophagogastric junction: a case report

Honda¹,

Sakamoto²,

Shoichi³

et al. 2019

surg case rep

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“…Recently, a case of aortoen-teric fistula at the esophagojejunostomy site after LTG for advanced gastric cancer located at the esophagogastric junction was reported. 12 Although two EPF cases associated with open total gastrectomy for gastric cancer have been reported, 3,4 there have been no reports of EPF induced by LTG for gastric cancer. To the best of our knowledge, our case is the first report of an EPF induced by LTG for gastric cancer.…”

Section: Discussionmentioning

confidence: 99%

Successful Treatment of an Esophagopericaridal Fistula with Pyopericardium That Developed after Laparoscopic Total Gastrectomy for Gastric Cancer by Intraoperative Stent Insertion

Kim

Park

et al. 2015

Korean J Helicobacter Up Gastrointest Res

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Esophagopericardial fistula (EPF) is a rare and serious medical condition induced by benign and malignant causes. Surgery is the main stay of treatment for benign EPF. However, there have been few reports of benign EPF treated by endoscopic stent insertion. We performed a laparoscopic total gastrectomy for treatment of a gastric cancer located at the cardia in a 62-year-old patient. A benign EPF occurred as a postoperative complication 14 days after surgery. We successfully managed the EPF through emergent laparoscopic pericardial window formation and insertion of a fully covered self-expendable metal stent during operation. The patient is being followed up without complications in the outpatient department after stent removal.

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“…There are occasional reports of aortoesophageal fistula after esophagectomy or esophageal stenting. However, aortoenteric fistula after gastrointestinal surgery is rarely seen [Gunji 2014].…”

Section: E24mentioning

confidence: 99%

Severe Upper Gastrointestinal Bleeding from Aortoenteric Fistula: A Late Complication of Esophagojejunostomy

Ezelsoy

Çoner

Cicek

2015

HSF

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Aortoenteric fistula is an uncommon cause of upper gastrointestinal bleeding, which is life-threatening if not treated. This complication may occur even months to years after surgery [Mitchel 1995]. It is commonly observed in patients who have undergone previous aortic surgery and rarely occurs in patients with a history of gastrointestinal tract surgery [Brock 1953]. The diagnosis of aortoenteric fistula depends on a high level of clinical suspicion. Herein, we report a case of a 53-year-old man who underwent surgical treatment because of new-onset severe gastrointestinal bleeding that was related to an aortoenteric fistula.

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Aortoenteric fistula at the site of esophagojejunostomy after laparoscopic total gastrectomy: report of a case

Cited by 9 publications

References 25 publications

Aortoenteric fistula following overlap esophagojejunal anastomosis using linear staplers for cancer of the esophagogastric junction: a case report

Aortoenteric fistula following overlap esophagojejunal anastomosis using linear staplers for cancer of the esophagogastric junction: a case report

Successful Treatment of an Esophagopericaridal Fistula with Pyopericardium That Developed after Laparoscopic Total Gastrectomy for Gastric Cancer by Intraoperative Stent Insertion

Severe Upper Gastrointestinal Bleeding from Aortoenteric Fistula: A Late Complication of Esophagojejunostomy

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