Benign post-esophagectomy gastrocardiac fistula

Gastric tube perforation penetrating the pericardium after esophagectomy that needed surgical repair

Background

As the prognosis of esophageal cancer surgery has improved, reports on postoperative complications of gastric tubes have increased. Among them, gastric tube ulcer perforation is infrequent but often severe and difficult to treat.

Case Presentation

A 73-year-old man had undergone thoracoscopic subtotal esophagectomy and laparoscopic-assisted gastric tube reconstruction via the retrosternal route for thoracic esophageal cancer 8 years previously. He was transferred to our hospital with a diagnosis of gastric tube ulcer perforation, penetrating the pericardium. Emergency surgery was performed to remove the gastric tube, followed by immediate reconstruction by right colon interposition. The patient was discharged on postoperative day 142.

Conclusion

We report a rare complication of gastric tube ulcer perforation, penetrating the pericardium, after esophagectomy for esophageal cancer. It was successfully treated with appropriate surgical management.

A Novel and Successful Repair of a Left Atriogastric Fistula After Esophagectomy

Atriogastric fistulas remain a rare adverse event in patients who undergo esophagectomy with gastric pullthrough. The presentation of an atriogastric fistula ranges from self-limited gastrointestinal bleeding to life-threatening hemorrhage, end-organ dysfunction from septic emboli, or both. These fistulas are associated with significant mortality. Previous reports describe successful repairs of gastrocardiac fistulas with the use of cardiopulmonary bypass. This report describes a patient with a significant burden of cerebral embolic disease, which therefore required a unique approach to fistula repair.

Successful repair of benign left atriogastric fistula after transhiatal esophagectomy

Benign gastrocardiac fistula is a rare complication following esophagectomy that can occur when the gastric tube is placed in the retrosternal space. We describe a benign fistula between the left atrium and the gastric conduit following transhiatal esophagectomy. The surgical technique that was used for successfully repair is also discussed.