Intrathoracic anastomotic leak after esophagojejunostomy in a patient with preoperative coronavirus disease 2019: A case treated with T-tube drainage.

INTRODUCTION

Intrathoracic anastomotic leakage can lead to severe complications, such as mediastinitis and empyema, with a high mortality rate. However, the optimal treatment strategy for anastomotic leakage remains controversial.

PRESENTATION OF CASE

This case involves a 55-year-old male patient with esophagogastric junction cancer who experienced intrathoracic anastomotic leakage following esophagojejunostomy, exacerbated by coronavirus disease 2019 (COVID-19)-related immunodeficiency. Following conservative therapy, the patient had a right-sided empyema, necessitating thoracoscopic pleural decortication on postoperative day (POD) 35. A T-tube was inserted at the anastomotic site, and its short limb maintained stability within the lumen, facilitating fistula formation. Postoperatively, the patient's body temperature and inflammatory markers gradually returned to normal. Oral intake was resumed on POD68, and the T-tube was removed on POD79. Subsequently, the patient was transferred to another hospital for rehabilitation on POD96.

DISCUSSION

In this patient with COVID-19 infection and systemic sepsis, T-tube drainage facilitated fistula formation and ensured continuous decompression at the anastomotic site, contributing to successful conservative management.

CONCLUSION

T-tube drainage may be an effective and feasible treatment option for intrathoracic anastomotic leakage in patients with severe immunodeficiency.