Oka Shinichi, Sakuramoto Shinichi, Chuman Motohiro, Aratani Kenichi, Wakata Mitsuo, Miyawaki Yutaka, Gunji Hisashi, Sato Hiroshi, Okamoto Koujun, Yamaguchi Shigeki, Koyama Isamu
Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan.
BMC Res Notes. 2017 Jul 11;10(1):267. doi: 10.1186/s13104-017-2589-6.
Anastomotic leakage after total gastrectomy occurs despite improvements in surgical techniques and patient management. Although many cases of dehiscence can be managed non-operatively, major leakage requires a second surgery and can potentially lead to death. Therefore, accurate and immediate diagnosis and treatment are essential.
In this report, we describe a 66-year-old Japanese man who was diagnosed with a complete separation of an esophagojejunal anastomosis after laparoscopic total gastrectomy with oral contrast radiography using Gastrografin. The severe complication was successfully treated by re-anastomosis after two emergency drainage surgeries. After the second surgery, the esophageal end formed a fistula with the jejunum, but balloon dilation failed to open the fistula. Therefore, oral ingestion and conservative treatment were considered unsuitable, and we performed esophagojejunal re-anastomosis 7 months after the first surgery. At a follow-up examination 2 years after re-anastomosis, the patient weighed 47 kg, and his ingestion had recovered to 80% of that before surgery.
Complete separation of an esophagojejunal anastomosis is a rare but severe complication of total gastrectomy. Therefore, we consider that once separation is diagnosed, aggressive and urgent re-operation and effective drainage are useful. Moreover, it is necessary to take great care to minimize the operative morbidity associated with esophagojejunal anastomosis.
尽管手术技术和患者管理有所改进，但全胃切除术后仍会发生吻合口漏。虽然许多裂开病例可通过非手术方式处理，但严重漏出需要二次手术，且可能导致死亡。因此，准确及时的诊断和治疗至关重要。
在本报告中，我们描述了一名66岁的日本男性，他在腹腔镜全胃切除术后经口服泛影葡胺造影被诊断为食管空肠吻合口完全分离。在两次急诊引流手术后，通过再次吻合成功治疗了这一严重并发症。第二次手术后，食管末端与空肠形成了瘘管，但球囊扩张未能打开瘘管。因此，口服摄入和保守治疗被认为不合适，我们在第一次手术后7个月进行了食管空肠再次吻合。再次吻合术后2年的随访检查中，患者体重47公斤，其摄入量已恢复至术前的80%。
食管空肠吻合口完全分离是全胃切除术后一种罕见但严重的并发症。因此，我们认为一旦诊断出分离，积极紧急的再次手术和有效的引流是有用的。此外，必须格外小心以尽量减少与食管空肠吻合相关的手术发病率。
