Gastric tube perforation after esophagectomy for esophageal cancer

Ubukata, Hideyuki; Nakachi, Takeshi; Nagata, Hiroyuki; Takemura, Akihiro; Shimazaki, Jun; Konishi, Satoru; Tabuchi, Takafumi

doi:10.1007/s00595-010-4476-9

Cited by 22 publications

(28 citation statements)

References 60 publications

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“…The frequency of peptic ulcer in the reconstructed gastric tube was reported to be 6.6–19.4% [ 12 – 15 ]. The mortality of patients with perforation of gastric tube ulcer was 56.5% in the review of Japanese literature and 84.6% in the review of the English literature [ 16 ]. Once gastric tube ulcer develops to gastro-aortic fistula, it causes a fatal result.…”

Section: Case Presentationmentioning

confidence: 99%

Tracheoesophageal fistula after total resection of gastric conduit for gastro-aortic fistula due to gastric ulcer

et al. 2017

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BackgroundTracheoesophageal fistula (TEF) is a rare but life-threatening complication after esophagectomy. It has a high mortality rate and often leads to severe aspiration pneumonia. Various types of surgical repair procedures have been reported, but the optimal management of TEF is challenging and controversial. Treatment should be individualized to each patient.Case presentationA 66-year-old female underwent transthoracic esophagectomy with gastric tube reconstruction and an intrathoracic anastomosis for esophageal cancer. Three years later, she had hematemesis and was diagnosed with a gastro-aortic fistula due to a gastric ulcer. She underwent endovascular aortic repair urgently at another hospital. Two days later, she underwent total resection of the gastric tube, during which time an injury to the trachea occurred; it was repaired by patching the stump of the esophagus to the injury site. Two months later, descending aortic replacement was performed due to infection of the stent graft. Six months after the first operation, a TEF developed. The patient was referred to our hospital for further treatment. The fistula was ligated and divided via a cervical approach, and a pectoralis major muscle flap was used to cover the defect. Esophageal reconstruction with the pedunculated jejunum was performed via a subcutaneous route. The postoperative course was uneventful. The patient was discharged after 6 months of physical and dysphagia rehabilitation.ConclusionA TEF located near the cervicothoracic border was successfully treated with a pectoralis major muscle flap through a cervical approach. Total resection of a gastric conduit in the posterior mediastinum carries a risk of tracheobronchial injury; however, if such an injury occurs, surgeons should be able to repair the injury using a suitable flap depending on the injury site.

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Section: Case Presentationmentioning

confidence: 99%

Tracheoesophageal fistula after total resection of gastric conduit for gastro-aortic fistula due to gastric ulcer

et al. 2017

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“…Gastric tube ulcer is quite common, being reported in 2,6%-19,4% of cases [ 2 ]. One of its most dreaded complications is gastric tube perforation, which is associated with up to 84,6% mortality rates [ 3 ]. A tailored management is necessary, depending on the site of perforation and on patient conditions.…”

Section: Introductionmentioning

confidence: 99%

Gastric conduit perforation after Ivor Lewis esophagectomy successfully treated with endoscopic vacuum therapy (E-VAC): a case report

Hetoja

Pasqual

Mengardo

et al. 2020

Journal of Surgical Case Reports

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Gastric conduit perforation is a life-threatening complication after esophagectomy and currently there is no consensus about its optimal management. Endoscopic vacuum therapy (E-VAC) is a promising technique for the treatment of leaks and perforations after upper gastro-intestinal surgery. We report the case of a 65 years-old male patient who underwent an Ivor Lewis esophagectomy for esophago-gastric junction adenocarcinoma. He referred to our Emergency Department for septic shock and right hydropneumothorax. We performed an emergency thoracoscopy with intraoperative esophagogastroduodenoscopy which showed a pre-pyloric perforation of the gastric conduit. The perforation was initially treated with unsuccessful primary surgical closure and subsequently by means of E-VAC, firstly placed intraluminal and then intracavitary. With the latter technique, we assisted to a progressive clinical improvement until the definitive healing of the perforation. To our knowledge, this is the first case of a gastric tube perforation after esophagectomy successfully treated with E-VAC.

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“…An ulcer, which could induce a perforation, is more prevalent in gastric tube patients than in the those with a normal healthy stomach. Helicobacter pylori infection, insufficient blood supply, gastric stasis and bile juice regurgitation play irrefutable roles in the formation of gastric tube ulcers and perforations [ 2 ]. Although these perforations are rare and often asymptomatic, severe septic conditions can be caused, which might ultimately result in a high morbidity and mortality [ 3 ], and even perforate the heart, pericardium and thoracic aorta [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

Endoscopic closure of gastric tube perforations with titanium clips: a four-case report

Zhan

Wang

et al. 2015

World J Surg Onc

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Perforation of a gastric tube is a rare yet lethal complication after esophagectomy for esophageal cancer treatment. Currently, over-the-scope clip (OTSC) is an effective way to treat gastric tube perforation. Due to the lack of OTSCs, we invented an alternative method composed of a titanium clip and gastroscope. The aim of this study was to describe this novel endoscopic device in the treatment of gastric tube perforation. We used a titanium clip system to treat 4 male patients (range, 53 to 77 years with gastric tube perforation. After the location of the perforation was identified by gastroscope, a titanium endoscopic clip was used to close the perforation. Successful closure of the gastric tube perforation was achieved in three patients while in one patient this failed due to his refusal to undergo reoperation. No postoperative complication was found in the three patients whose perforations were closed and the patient who refused reoperation died due to the reoccurrence of his esophago-cardiac carcinoma. The endoscopic system composed of titanium clip and gastroscope proved to be an efficient and effective device in the treatment of the patients with gastric tube perforations.

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Gastric tube perforation after esophagectomy for esophageal cancer

Cited by 22 publications

References 60 publications

Tracheoesophageal fistula after total resection of gastric conduit for gastro-aortic fistula due to gastric ulcer

Tracheoesophageal fistula after total resection of gastric conduit for gastro-aortic fistula due to gastric ulcer

Gastric conduit perforation after Ivor Lewis esophagectomy successfully treated with endoscopic vacuum therapy (E-VAC): a case report

Endoscopic closure of gastric tube perforations with titanium clips: a four-case report

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