A Case Report of Necrosis of the Substituted Stomach due to Compression by the Right Bronchial Artery and the Azygos Arch after Radical Surgery for Esophageal Cancer

Yosuke Fukunaga, Masayuki Higashino, Shinya Tanimura, Yasuhisa Fujimoto, Kenji Mizugami, Osamu Yamazaki, Mitsuharu Matsuyama, Katsuhiko Horii, Masahiro Okuno and Sanae Hirata

Department of Surgery, Osaka City General Hospital, Osaka, Japan

A 59-year-old man was admitted in May 1996 due to esophageal cancer of the upper thoracic esophagus, of a protruding, superficial, expanding type that was unstained by iodine. After neoadjuvant chemotherapy with a combination of cisplatin and 5-FU for 2 weeks, a radical operation with 3-field lymphadenectomy was performed. A digestive reconstruction was made by intrathoracic esophago-gastrostomy. On the fourth postoperative day, the patient demonstrated vital instability caused by severe mediastinitis due to an anastomotic leak. A thoracotomy was redone and the proximal one-third of the substituted stomach was confirmed to have necrosis and perforation because of comression of the right bronchial artery and the azygos arch. Resection of the necrotic part of the stomach and plueral lavage were performed and a cervical esophagostomy was made. The patient's condition improved despite transitional multiple organ failure about three months later. A digestive reconstruction was performed using the left colon while the patient was stable and he was discharged seven months later. Although intrathoracic esophago-gastrostomy has been considered a safe option, this report seems to be the first case of such a severe complication. We must consider the anatomical positions of the substituted stomach and the right bronchial artery and azygos arch when we performe a digestive reconstruction following surgery for esophageal cancer.

Key words
necrosis of substituted stomach, esophageal cancer, intrathoracic esophagogastrostomy

Reprint requests
Yosuke Fukunaga Department of Surgery, Osaka City General Hospital 2-13-22 Miyakojimahondori Miyakojima-ku Osaka, 534-0021 JAPAN

Accepted
December 9, 1998

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