AI Article Synopsis
- The development of an esophago-bronchial fistula is a rare but serious complication following esophagectomy, leading to high mortality rates.
- A 63-year-old man experienced this complication after surgery for esophageal cancer, facing respiratory failure due to severe reflux and ischemia at the surgical site.
- A novel three-step surgical approach was successfully implemented to address the fistula and restore esophageal function, demonstrating potential for patients unable to undergo traditional surgical interventions.
Article Abstract
Background: The development of esophago-bronchial fistula after esophagectomy and reconstruction using a posterior mediastinal gastric tube remains a rare complication associated with a high rate of mortality.
Case Presentation: A 63-year-old man with esophageal cancer underwent a thoracoscopic esophagectomy with two-field lymph node dissection and reconstruction via a gastric tube through the posterior mediastinal route. Postoperatively, the patient developed extensive pyothorax in the right lung due to port site bleeding and hematoma infection. Four months after surgery, he developed an esophago-left bronchial fistula due to ischemia of the cervical esophagus and severe reflux esophagitis at the site of the anastomosis. Because of respiratory failure due to the esophago-bronchial fistula and the history of extensive right pyothorax, right thoracotomy and left one-lung ventilation were thought to be impossible, so we decided to perform the surgery in three-step systematically. First, we inserted a decompression catheter and feeding tube into the gastric tube as a gastrostomy and expected neovascularization to develop from the wall of the gastric tube through the anastomosis after this procedure. Second, 14 months after esophagectomy, we constructed an esophagostomy after confirming blood flow in the distal side of the cervical esophagus via gastric tube using intraoperative indocyanine green-guided blood flow evaluation. In the final step, we closed the esophagostomy and performed a cervical esophago-jejunal anastomosis to restore esophageal continuity using a pedicle jejunum in a Roux-en-Y anastomosis via a subcutaneous route.
Conclusion: This three-step operation can be an effective procedure for patients with esophago-left bronchial fistula after esophagectomy, especially those with respiratory failure and difficulty in undergoing right thoracotomy with left one-lung ventilation.
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Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8672548 | PMC |
| http://dx.doi.org/10.1186/s12876-021-02051-6 | DOI Listing |
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