Closure of Reconstructed Gastric Tube-Right Main Bronchial Fistula after Operation for Esophageal Cancer, with Transposition of a Pedicled Pectralis Major Muscle Flap -Report of a Successful Surgical Therapy Case-

Hajime Saitoh, Shichisaburou Abo, Michihiko Kitamura, Masaji Hashimoto, Keniichi Izumi, Kazuo Tenma, Makio Mike*

Second Department of Surgery, Akita University School of Medicine
*Department of Surgery, Kakunodate Municipal General Hospital

We experienced reconstructed gastric tube-right main bronchial fistula after radical operation for esophageal cancer, and report successful surgical therapy by transposition of a pedicled pectralis major muscle flap. The patient was a 63-year-old man who underwent total thoracic esophagectomy with reconstruction of the gastric tube through the posterior mediastinal route for esophageal cancer, on July 14, 1993. As there were no findings of anastomotic leakage or passage disturbance on esophageal fluoroscopy, oral intake was started on the l3th postoperative day (POD). But he coughed up gastric content and saliva. He repeatedly suffered aspiration pneumonia, and nutrition support was performed using a central venous catheter and a jejunal feeding tube. On the 120th POD, gastric tube-right main bronchial fistula was detected on esophageal fluoroscopy. The second operation, closure of the fistula with transposition of a pedicled third intercostal muscle flap, was performed on November 21, 1993. But pyothorax occurred as a complication, and on the 40th POD, the fistula recurred. The third operation, with transposition of a pedicled pectralis major muscle flap, was performed on May 14, 1994. After the operation, he improved dramatically. The cause of the fistula was considered to be local circulatory disorder on the staple line of the autosuture on the gastric tube.

Key words
postoperative state of esophageal cancer, gastric tube-bronchial fistula, transposition of a pedicled pectralis major muscle flap

Reprint requests
Hajime Saitoh Second Department of Surgery, Akita University School of Medicine
1-1-1 Hondoh, Akita, 010 JAPAN

Accepted
April 5, 1995

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