Gastric Tube-Pulmonary Fistula after Esophageal Reconstruction Treated by Endoscopic Fibrin Glue Injection: A Case Report

Masashi Hanai, Youichiro Kobayashi, Kanji Miyata, Fumihiko Yoneyama, Tatsuo Hattori and Norihiro Yuasa^*

Department of Surgery, Japanese Red Cross Nagoya First Hospital First Department of Surgery, Nagoya University School of Medicine^*

We successfully treated a gastric tube-pulmonary fistula after esophageal reconstruction by endoscopic fibrin glue injection. A 60-year-old man underwent subtotal esophagotomy and esophago-gastric tube anastmosis through a right thoracotomy. The postoperative course was uneventful. An upper gastrointestinal series on the 8th postoperative day did not show any abnormal findings. Since the left cardiac lymph nodes showed metastasis, we underwent chemotherapy for five days from the 21st postoperative day. The patient left our hospital on the 34th postoperative day. Three months later he developed a fever and cough, and we diagnosed pneumonia and pulmonary abscess. Leakage of the esophago-gastric anastmosis was observed on an upper gastrointestinal series, and a diagnosis of gastric tube-pulmonary fistula was made. The pneumonia was ameliorated by without oral feeding and injection of antibiotics, but the fistula persisted. The fistula was closed by endoscopic fibrin glue injection. The patient resumed oral feeding on the 6th day after the procedure, and there has been no evidence of recurrence for 2 years.

Key words
broncho-esophageal fistula, fibrin glue, gastric tube-pulmonary fistula

Reprint requests
Masashi Hanai Department of Surgery, Japanese Red Cross Nagoya First Hospital 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511 JAPAN

Accepted
December 19, 2000

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