Peptic Ulcer in a Pulled-up Gastric Tube After Esophageal Replacement Perforating into the Aortic Arch -Report of a Successfully Managed Case-

Kazuo Yasumoto, Tadayuki Toyoda, Kazushige Touyama, Jyoji Iseki, Masakazu Takagi, Kazuhiko Nakagami, Kouji Hakamada, Tamaki Noie, Naoki Takabayashi, Fumitaka Andou*, Tomomi Ogino¹⁾, Masayoshi Mai¹⁾

Department of Surgery and Department of Cardiovascular Surgery*, Shizuoka Prefectural General Hospital
Department of Surgery, Cancer Research Institute Hospital, Kanazawa University¹⁾

A 49-year-old woman presented with stage IV esophageal cancer in August 1986. She underwent total resection of the intrathoracic esophagus with esohageal replacement via the retrosternal route by means of a gastric tube and pyloroplasty. Post-operative radiation was given and the subsequent post-operative course was satisfactory. One year and 8 months after esophagectomy, she consulted us again in a state of shock, complaining hematemesis and melena. Emergency endoscopic examination revealed a deeply ulcerative lesion on the posterior wall of the gastric tube with massive blood coaglation. She suddenly developed cardiac arrest and apnea during an endoscopic examination, and massive fountain-like hematemesis appeared. An immediate emergency operation was performed, during which resuscitative measures were undertaken. A median sternotomy was made, and the ulceration was seen to have perforated the anterior wall of the aortic arch. We were able to stop the bleeding by directly suturing the bleeding point, and she was rescued. Reports of ulcerrative lesions developing in a gastric tube used for esophageal replacement are rare, with only 5 cases reported in Japan. No cases have been reported in which perforation into the aortic arch was successfully treated.

Key words
esophageal cancer, gastric tube, peptic ulcer

Reprint requests
Kazuo Yasumoto Department of Surgery, Cancer Research Institute Hospital, Kanazawa University
4-86 Yoneizumi, Kanazawa, 921 JAPAN

Accepted
June 13, 1990

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