A Case of Intractable Esophageal Fistula Repaired by a Patch of the Iliotibial Tract and Pectoralis Major Muscle Prombage

Abstract

The patient was in his seventies who had undergone subtotal esophagectomy and anastomosis of the cervical esophagus and gastric tube for esophageal cancer 12 years previously. Five years later, he suffered from anastomotic stenosis during chemoradiotherapy for cervical node recurrence. Eight months previously, he suffered from intractable esophageal fistula because of anastomotic leakage from re-anastomosis surgery. We performed pectoralis major muscle prombage because we judged that the repair with a free jejunal graft was not acceptable due to his poor general condition. The fistula was repaired by patching the iliotibial tract and pectoralis major muscle prombage. The patient had an uncomplicated postoperative course and changed hospitals on the 38th post-operative day. Pectoralis major muscle prombage for esophageal fistula requires blocking sialic leakage for engraftment of the prombage tissue. Patch repair with a skin flap for the closure of the fistula is a cumbersome procedure and often requires skin grafting. By contrast, patch repair using the iliotibial tract was easy and useful for the closure of the esophageal fistula.