Purulent spondylitis related to anastomotic fistula after esophageal cancer surgery

Kakuta, Tomoyuki; Kosugi, Shin‐ichi; Kanda, Tatsuo; Hatakeyama, Katsuyoshi

doi:10.1510/icvts.2010.235515

Cited by 8 publications

(8 citation statements)

References 8 publications

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“…To comprehensively analyze the risk factors of anastomotic leak, first of all, it is emphasized that a precise and scrupulous surgical technique plays a decisive role in the healing of anastomotic tissue. Precise surgical operation needs to ensure firm and stable tissue closure, good blood supply to the stomach or other organs replacing the esophagus and targeted treatment of anastomotic tension 3–7 . At present, gastric conduit, especially the thin conduit replacing the esophagus, has been accepted by more and more surgeons.…”

Section: Complex Clinical Presentations and Possible Causes Of Anasto...mentioning

confidence: 99%

Update on therapeutic strategy for esophageal anastomotic leak: A systematic literature review

et al. 2022

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Anastomotic leak is still a severe complication in esophageal surgery due to high mortality. This article reviews the updates on the treatment of anastomotic leak after esophagectomy in order to provide reference for clinical treatment and research. The relevant studies published in the Chinese Zhiwang, Wanfang, and MEDLINE databases to December 21, 2021 were retrieved, and esophageal carcinoma, esophagectomy, anastomotic leakage, and fistula selected as the keywords. A total of 78 studies were finally included. The treatments include traditional surgical drainage, new reverse drainage trans-fistula, stent plugging, endoscopic clamping, biological protein glue injection plugging, endoluminal vacuum therapy (EVT), and reoperation, etc. Early diagnosis, accurate classification and optimal treatment can promote the rapid healing of anastomotic leaks. EVT may be the most valuable approach, simultaneously with good commercial prospects. Reoperation should be considered in patients with complex fistula in which conservative treatment is insufficient or has failed.

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Section: Complex Clinical Presentations and Possible Causes Of Anasto...mentioning

confidence: 99%

Update on therapeutic strategy for esophageal anastomotic leak: A systematic literature review

et al. 2022

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“…Although there are several reports of PS following investigations or treatment for cancers, such as transoral surgery and chemoradiotherapy for head and neck cancers,24 25 surgical resection for oesophageal cancer26 and transrectal prostate biopsy for prostate cancer,27 this is the first report of PS following ESD for early gastric cancer. In conclusion, we experienced a rare case of PS following gastric ESD.…”

Section: Discussionmentioning

confidence: 90%

Pyogenic spondylitis following endoscopic submucosal dissection for early gastric cancer

et al. 2022

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A man in his 80s who had a history of diabetes mellitus and aortic valve replacement was referred to our hospital for treatment of early gastric cancer and underwent endoscopic submucosal dissection (ESD). Three days after ESD, the patient presented with low back pain and fever (38.7°). We initially considered adverse events associated with gastric ESD such as delayed perforation. Moreover, thromboembolism and infectious endocarditis were suspected because of his medical history. However, there were no remarkable findings suggestive of these diseases. Finally, based on the results of blood cultures and MRI, the diagnosis of pyogenic spondylitis (PS) was made. We administered antibiotics for 12 weeks, and the patient improved without neurological impairments. This case indicates that bacteraemia and subsequent PS can occur following gastric ESD. Physicians should not overlook the patient’s physical signs related to various adverse events after ESD.

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“…However, these postoperative sequelae after esophagectomy are extremely rare. Kakuta and Mecklenburg have reported an extremely rare case of esophagospinal fistula with cervical spondylodiscitis after esophagectomy with gastric tube [7,8]. These patients had received neoadjuvant chemotherapy or chemoradiotherapy for carcinoma of the thoracic esophagus, which is associated with immunosuppression.…”

Section: Discussionmentioning

confidence: 99%

“…These patients had received neoadjuvant chemotherapy or chemoradiotherapy for carcinoma of the thoracic esophagus, which is associated with immunosuppression. Kakuta et al [7] have reported that intraoperative injury in the prevertebral fascia is a causative factor. In 1995, Iannettoni et al [13] have reported that among 856 patients who underwent a cervical esophagogastric anastomosis after transhiatal esophagectomy, 3 (n = 1, vertebral body osteomyelitis; n = 2, epidural abscess with neurologic impairment) presented with cervical osteomyelitis.…”

Section: Discussionmentioning

confidence: 99%

“…Cases of pyogenic spondylitis of the cervical spine that occurs after treatment for esophageal and laryngeal cancer/trauma have been discussed in previous studies [4][5][6]. Furthermore, a few reports have revealed that pyogenic spondylitis of the cervical spine is related to anastomotic fistula that occurs after surgery for esophageal cancer [7,8]. Herein, we report the case of pyogenic spondylodiscitis of the lumbar spine that occurred after surgery for advanced esophageal cancer.…”

Section: Introductionmentioning

confidence: 88%

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Pyogenic spondylodiscitis of the lumbar spine related to anastomotic fistula after surgery for esophageal cancer: a case report

et al. 2020

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Background: Pyogenic spondylodiscitis is an extremely rare complication of esophagectomy for esophageal cancer. Case presentation: A 70-year-old Japanese man, with a previous medical history of type 2 diabetes mellitus, coronary artery disease, and laryngeal cancer, received neoadjuvant chemotherapy and underwent thoracoscopic esophagectomy with gastric tube reconstruction for advanced esophageal cancer. Cervical esophagogastrostomy with circular-stapled end-to-side anastomosis was performed. However, partial necrosis in the gastric tube developed to form refractory anastomotic fistula. Two months after the initial surgery, debridement and free jejunal transfer reconstruction with the pectoralis major muscle flap were performed. Although the postoperative course of the second surgery was uneventful, the patient complained of severe lower back pain and fever. The patient was diagnosed with pyogenic spondylodiscitis according to the results of the magnetic resonance imaging. Enterobacter cloacae were isolated from the arterial blood culture. Sensitive antibiotics were administered continuously, and the patient required to use a lumbar corset for 2 months. Subsequently, his physiological signs and symptoms had completely disappeared. Conclusion: To the best of our knowledge, this case study is the first study that reported pyogenic spondylodiscitis of the lumbar spine, a complication of cervical anastomotic fistula after surgery for advanced esophageal cancer.

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Purulent spondylitis related to anastomotic fistula after esophageal cancer surgery

Cited by 8 publications

References 8 publications

Update on therapeutic strategy for esophageal anastomotic leak: A systematic literature review

Update on therapeutic strategy for esophageal anastomotic leak: A systematic literature review

Pyogenic spondylitis following endoscopic submucosal dissection for early gastric cancer

Pyogenic spondylodiscitis of the lumbar spine related to anastomotic fistula after surgery for esophageal cancer: a case report

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