Oesophageal anastomotic leak and fistula are major and life-threatening complications of oesophagectomy with resultant increased mortality. Non-operative approach of such cases should be the initial strategy. Re-operative surgery and/or stent insertion are considered if conservative measures failed. Although oesophageal stenting is a safe option for the leaks, stent migration and failure to completely cover large anastomotic leaks are the main complications and pitfalls of the procedure. These can be overcome by using multiple or larger stents. We describe a case of a 73-year-old man who underwent a laparoscopic oesophagectomy for an oesophageal adenocarcinoma. The procedure was complicated by a large gastro-pleural fistula and anastomotic leak, resulting into a chronic empyema. The initial conservative treatment and a conventional oesophageal stent insertion failed to heal the fistula and to resolve the empyema. Re-operative surgery was ruled out because of the patient's poor general health and high surgical risk. Due to the changed oesophago-gastric anatomy and a potential risk of migration of the additional conventional stent, a mega stent was deployed with successful closure of the oesophageal leak. Post-stenting contrast studies and an out-patient follow up review of the case confirmed no further anastomotic leakage.
Paraneoplastic syndromes are rare initial manifestations of a neoplastic disorder that may precede the actual detection of an overt cancer. These syndromes can generally involve any organic system of the human body with gastroparesis being the commonest manifestation of the paraneoplastic involvement of the neuronal bodies of the gastrointestinal tract in cancer patients. Gastroparesis is the result of an autoimmune destruction of the nerve plexus of the stomach that causes nonspecific gastrointestinal symptoms such as intractable vomiting and abdominal discomfort that interfere with patients' quality of life and are often ascribed to psychological factors. Thus, if not suspected, it easily evades the diagnostic thought especially in those cases where the diagnostic work up has not detected any apparent cause. Consequently, it should always be considered in patients with diagnosed or suspected cancer who complain of unexplained gastrointestinal symptoms. In our report, so as to increase the clinical awareness of this rare clinical entity, we present the case of a 70-year-old Caucasian female who presented in our hospital with severe gastroparesis that was later proven to be associated with an overt small cell lung cancer (SCLC) and we discuss the existing knowledge of the pathophysiology, diagnosis, and management of this disorder.
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