[A successful case of surgical treatment for the bronchogastric tube fistula originated in the reconstructed gastric tube after operation for esophageal cancer].

A successful case of surgical treatment for a bronchogastric tube fistula after resection for esophageal cancer are reported herein. The patient was a 67-year-old male who had undergone blunt total esophagectomy with reconstruction of a whole gastric tube pulled up through the posterior mediastinum and laryngopharyngectomy with a permanent end-tracheostomy in February, 1983. After the operation, he was irradiated prophylactically to the both neck and upper mediastinum with a total dose of 50 Gy. He showed no sign of recurrence. But 11 years after the operation, he complained excretion of food from his tracheostomy. Endoscopical examination on admission revealed an ulcer in the anterior wall of the reconstructed gastric tube penetrating to the right main bronchus. He was treated conservatively, but endoscopy didn't reveal the ulcer in healing. So we performed an operation. At first the gastric tube and the right main bronchus were divided. Then we attempted to close each fistula. We could suture the gastric tube wall tightly. The membranous wall of bronchus around the fistula was weak, but we could close that fistula without air leak by using the azygos vein flap. His postoperative course was uneventful. We consider that postoperative irradiation, administration of antibiotics, and bile reflux etc. might play significant role in development of the penetrating ulcer.