Gastro-tracheal fistula - unusual and life threatening complication after esophagectomy for cancer: a case report

Abstract

BackgroundA gastro-tracheal fistula following esophagectomy for cancer is a rare but potentially lethal complication. We report the successful surgical closure after failed endoscopic treatment, of a gastro-tracheal fistula following esophago-gastrectomy for cancer after induction chemo-radiotherapy.Case presentationA 58 year-old male patient presented with a distal third uT3N1 carcinoma of the esophagus. After induction chemo-radiotherapy, he underwent an esophago-gastrectomy with radical lymphadenectomy and reconstruction by gastric pull-up. Immediate postoperative outcome was uneventful. On the 15th postoperative day however, our patient was readmitted in the Intensive Care Unit with severe bilateral basal pneumonia. Three days later a gastro-tracheal fistula was diagnosed upon gastroscopy and bronchoscopy. His good general condition allowed for an endoscopic primary approach which consisted in the insertion of a covered stent in the trachea along with clipping and glueing of the gastric fistular orifice. Two attempts proved unsuccessful.ConclusionAfter several weeks of conservative measures, surgical re-intervention through a right thoracotomy with transection of the fistula and closure by primary interrupted sutures of both fistular orifices along with intercostal muscle flap interposition led to excellent patient outcome. Oral feeding was started and our patient was discharged.

Management of Gastrointestinal Leaks After Minimally Invasive Esophagectomy: Conventional Treatments vs. Endoscopic Stenting

“…Treatment options include conservative management, or reoperation with take down of fistula and the use of muscle flap. [18][19][20] In our series, one patient in the conventional treatment group had tracheoesophageal fistula and required GI diversion and placement of a muscle flap. On the other hand, one patient in the ECS group had tracheoesophageal fistulae and was successfully treated with endoscopic stenting without the need for reoperation.…”

Özofagus Kanseri Nedeni ile Uygulanan Ivor-Lewis Operasyonu Sonucu Gelişen Katastrofik Komplikasyonlar: Olgu Sunumu

“…Medikal minör komplikasyonlar; fi zyolojik bozukluklar, aritmi, üriner sistem enfeksiyonları, diyare iken, majör komplikasyonlar kalp krizi, kalp yetmezliği, tromboembolik olaylar, pnömöni ve solunum yetmezliğidir. Cerrahi minör komplikasyonlar; yara enfeksiyonu, minör pnömotorax iken, majör komplikasyonlar anastomoz kaçakları, gastrotomi kaçakları, gastrik nekroz, toraks içine kanamalar, laringeal sinir paralizisi, ampiyem, gastro-mediastinal fi stül, bronkomediastinal fi stüldür (3)(4)(5). Operasyon sonrasında gelişen majör komplikasyonların tanısı mümkün olan en kısa sürede konulup tedavisi geciktirilmemelidir.…”

Esophagectomy for esophageal carcinoma - surgical complications and treatment

“…22 ). Clinically it is characterised by an alteration of the patient's overall condition with repeated aspirations and pneumonia 23 . The diagnosis is based on findings on the upper GI series, endoscopically and bronchoscopically 22,24 .…”