Successful Treatment of Reconstructed Gastric Tube-Bronchial Fistula after Resection of Esophageal Cancer by Pedunculated Diaphragm Flap

Toshisada Aiba, Takehito Katoh, Masaomi Suzuki, Yoshihisa Shibata, Kazuhiro Hiramatu, Motoi Yoshihara, Takashi Ikeyama and Kiyoshi Suzumura

Department of Surgery, Toyohashi Municipal Hospital

We report successfully treating a bronchial fistula due to a reconstructed gastric-tube after resection of esophageal cancer. A 62-year-old man diagnosed with esophageal cancer, and underwent subtotal esophagectomy followed by reconstruction using an intrathoracic gastric tube. Histological study of the specimen showed moderately differentiated squamous cell carcinoma with pStage I (pT1b and pN0). Discharged on postoperative day (POD) 18 without complication, he was readmitted 14 days after discharge with fever and coughing. Computed tomography (CT) scan, an upper gastrointestinal series, and endoscopy showed pneumonia due to gastric tube-bronchial fistula caused by a peptic gastric ulcer. Fistula persistence despite conservative pneumonia therapy, including respiratory support, necessitated further surgical intervention. In reoperation, the fistula between the gastric tube and the lung was separated off and closed with simple sutures. To prevent fistula reopening, a pedunculated diaphragm flap was patched over the closed gastric tube site. The man is doing well without recurrence 30 months after reoperation.

Key words
gastric tube-bronchial fistula, diaphragm flap, esophageal cancer

Reprint requests
Toshisada Aiba Department of Surgery, Yamashita Hospital
1-3-5 Nakamachi, Ichinomiya, 491-8531 JAPAN

Accepted
January 27, 2010

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