A Case of Refractory Cutaneo-sternal-gastric Tube Fistula after Resection of Esophageal Cancer

Hideki Kito, Ryugo Sawada, Masakazu Yashiro, Akira Hayashibe, Eiji Taruya, Kenzo Asada, Kanji Tokura, Jun Takebayashi

Department of Surgery, Izumi Municipal Hospital

We reported a case, cured conservatively, in which a cutaneu-sternal-gastric tube fistula was formed by penetration of a peptic ulcer through the sternum 4 months after resection of esophageal cancer. The patient was a 65-year-old man and the cutaneo-sternal-gastric tube fistula was located a few centimeters anal to the esophagogastrostomy in the anterior wall of the gastric tube. OK432·5KE/fibrinogen·80 mg solution was injected endoscopically into the edge of the fistula inside of the gastric tube three times at intervals of one and two weeks, and was injected into the edge of the cutaneous fistula once. Therefore granulation was accelerated and the fistula was closed. In Japan, 33 cases of a gastric tube ulcer after resection of esophageal cancer including our case have been reported. In 14 cases there was perforation or penetration, and in 10 of these cases surgery was performed. In 2 of the 4 cases in which surgery for a cutaneogastric tube fistula was performed, leakage at the suture line occurred, so it is very refractory. Our case is the only one in which the cutaneogastric tube fistula was cured conservatively.

Key words
esophageal cancer, peptic ulcer, cutaneo-sternal-gastric tube fistula

Reprint requests
Hideki Kito Department of Surgery, Izumi Municipal Hospital
4-10-10 Fuchu-cho, Izumi, 549 JAPAN

Accepted
September 9, 1992

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