Gastro-tracheal fistula following esophageal cancer surgery through the retrosternal route: a case report.

IF 0.7 Q4 SURGERY Surgical Case Reports Pub Date : 2024-11-04 DOI:10.1186/s40792-024-02052-z
Seitaro Nishimura, Kazuhiro Noma, Kento Kawasaki, Masashi Hashimoto, Takuya Kato, Naoaki Maeda, Shunsuke Tanabe, Yasuhiro Shirakawa, Toshiyoshi Fujiwara
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Abstract

Background: Gastro-tracheal fistula is a rare but serious complication after esophageal surgery, often requiring long-term treatment and invasive procedures. Gastro-tracheal fistula usually occurs through the posterior mediastinal route and rarely through the retrosternal route. No previous reports have described gastro-tracheal fistula after retrosternal route reconstruction was cured by conservative treatment.

Case presentation: A 70-year-old man with lower thoracic esophageal cancer underwent thoracoscopic esophagectomy in the prone position and gastric tube reconstruction through the retrosternal route with neck anastomosis after neoadjuvant chemotherapy. Despite anastomotic leakage on postoperative day 10, his general condition was stable, and he was managed conservatively with antibiotics and gastric tube decompression. On day 29, he presented with high fever and a gastro-tracheal fistula was observed by esophagography. Conservative management was continued because the patient remained stable. On day 48, esophagography showed that the fistula was undetectable. The patient was able to take fluids orally. He progressed well on an oral diet and was transferred to a different hospital.

Conclusions: A gastro-tracheal fistula, although rare, can occur after retrosternal route reconstruction. When a patient is stable, gastro-tracheal fistula after retrosternal route reconstruction may be cured by conservative treatment.

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经胸骨后途径进行食管癌手术后出现胃-气管瘘:病例报告。
背景:胃-气管瘘是食管手术后一种罕见但严重的并发症,通常需要长期治疗和侵入性手术。胃-气管瘘通常通过后纵隔途径发生,很少通过胸骨后途径。之前没有任何报道称胸骨后途径重建后的胃气管瘘能通过保守治疗治愈:一名患有下胸段食管癌的 70 岁男性在接受新辅助化疗后,在俯卧位接受了胸腔镜食管切除术,并通过胸骨后途径进行了胃管重建和颈部吻合术。尽管术后第 10 天出现吻合口漏,但他的全身情况稳定,并接受了抗生素和胃管减压等保守治疗。第 29 天,他出现高烧,食管造影观察到胃-气管瘘。由于患者病情保持稳定,保守治疗得以继续。第 48 天,食管造影显示无法检测到瘘管。患者能够口服液体。他在口服饮食方面进展顺利,并被转到另一家医院:胃-气管瘘管虽然罕见,但可在胸骨后途径重建术后发生。如果患者病情稳定,胸骨后路径重建术后的胃-气管瘘可能会通过保守治疗治愈。
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