Nishimura Seitaro, Noma Kazuhiro, Kawasaki Kento, Hashimoto Masashi, Kato Takuya, Maeda Naoaki, Tanabe Shunsuke, Shirakawa Yasuhiro, Fujiwara Toshiyoshi
Department of Gastroenterological Surgery, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan.
Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Naka-Ku, Hiroshima, Japan.
Surg Case Rep. 2024 Nov 4;10(1):252. doi: 10.1186/s40792-024-02052-z.
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.
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.
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.
胃气管瘘是食管手术后一种罕见但严重的并发症，常需长期治疗及侵入性操作。胃气管瘘通常经后纵隔途径发生，很少经胸骨后途径发生。既往尚无胸骨后途径重建术后胃气管瘘经保守治疗治愈的报道。
一名70岁男性，患有胸段下段食管癌，在新辅助化疗后，俯卧位行胸腔镜食管切除术，并经胸骨后途径行胃管重建及颈部吻合术。术后第10天尽管出现吻合口漏，但他的一般状况稳定，遂给予抗生素及胃管减压保守治疗。第29天，他出现高热，食管造影发现胃气管瘘。由于患者情况仍稳定，继续采取保守治疗。第48天，食管造影显示瘘口消失。患者能够经口进流食。他经口饮食情况良好，并转至另一家医院。
胃气管瘘虽罕见，但可在胸骨后途径重建术后发生。当患者情况稳定时，胸骨后途径重建术后的胃气管瘘可通过保守治疗治愈。
