A Case of Cardiac Tamponade due to Perforation of Peptic Ulcer in the Gastric Tube after Surgery for Esophageal Cancer

Akihisa Fukumoto, Akihiko Watanabe, Takatsugu Yamada, Hidetomo Sawada, Yukishige Yamada, Hiroshige Nakano, Makoto Takahama¹⁾, Souichirou Kitamura¹⁾

The First Department of Surgery, Nara Medical University
The Third Department of Surgery, Nara Medical University¹⁾

We report a very rare case of peptic ulcer occurring in the gastric tube and perforating the pericardium space resulting in cardiac tamponade. The patient is a 74-year-old man who received subtotal esophagectomy for esophageal cancer reconstructed by a gastric roll via the retrosternal route in 1986. In March 1991, five years after the primary surgery, endoscopy was performed because he felt a precordial pain. A peptic ulcer was revealed in the gastric tube. An antiacidic drug was orally administered and the peptic ulcer was cured. In May 1994, peptic ulceration recurred in the gastric tube and another antiacidic drug was administered. On 14th August 1994, severe precordial pain occurred suddenly and radiological examination revealed gas in the pericardial region. Soon he went into shock and cardiac tamponade was diagnosed. Immediately operative pericardial drainage was performed under left thoracotomy because esophageal replacement was reconstructed by a gastric roll via the retrosternal route. Then, his general condition improved gradually. He was discharged 60 days after surgery in a healthy condition. This is the first reported case of a patient who was rescued operatively from cardiac tamponade due to penetration of a peptic ulcer occurring in the gastric tube after esophagectomy for esophageal cancer.

Key words
cardiac tamponade, peptic ulcer in the gastric tube, esophageal cancer

Reprint requests
Akihisa Fukumoto The First Department of Surgery, Nara Medical University
840 Shijyou-chyou, Kashihara, 634 JAPAN

Accepted
February 12, 1997

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