Gastric Tube Ulcer that Could Be Saved by Early Conservative Treatment

Abstract

The patient was an 81-year-old man who had received subtotal esophagectomy for esophageal cancer reconstructed by a gastric tube via a posterior mediastinal route. He presented to our emergency room with a complaint of epigastric pain and a small amount of hematemesis. Thoracoabdominal computed tomography showed that the reconstructed gastric tube was filled fluid and had irregular wall thickening. We suspected upper gastrointestinal bleeding, and we started to treat with administration of proton pump inhibitors (PPIs) since the anemia was mild and his vitals were stable. However, his anemia was rapidly progressed to Hb 6.0 with a large amount of old blood melena. The emergency gastroscopy showed an A2 stage ulcer with active oozing at middle esophagus reconstructed by a gastric tube. Therefore, we applied thrombin spray to treat the bleeding. Fortunately, his recovery was progressing nicely with medical treatments for a week. In this study, we experienced a case in which early administration of PPIs might be a key player to prevent his medical condition worsened further.

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

“…In the posterior mediastinal route, gastric tube perforation generally occurs into the thoracic cavity, which is serious and sometimes fatal 1,5–8 . By contrast, retrosternal‐reconstructed gastric tube perforation is less severe due to the narrow space in the retrosternal cavity 9 . However, in the present case, due to the repeated gastric tube ulcer recurrence and chronic inflammation, penetration between the gastric tube and pericardium occurred, resulting in retrosternal and pericardial abscess formation.…”