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.
A 64-year-old man presented with haematemesis and melena. Repeated endoscopies showed extensive candidiasis with an exophytic mass like a shelf of tumour. Biopsies showed chronic inflammatory changes with candidiasis without evidence of malignancy. His only complaint was feeling tired and loss of energy. There was no dysphagia but slight retrostenal discomfort on swallowing. Computed tomography scan reported an opacification in the right upper lobe adjacent to the mediastinum. This contained air bronchograms and several irregular air filled cavities. There was significant mediastinal adenopathy. Two endoscopies were done after that and both of them demonstrated a fistulous connection with the bronchial tree. Biopsies failed to show any neoplasm. The patient underwent a three stage oesophagectomy with removal of the adjacent lung lobe and a reconstructive procedure. The resected mass was sent for histopathology which showed a well differentiated squamous cell carcinoma of the oesophagus which locally invaded the lung.
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