1996 Volume 57 Issue 6 Pages 1365-1370
A 66-year-old man underwent non-thoracotomy esophagectomy and posterior mediastinal route esophagogastric tube anastomosis at the cervical region for an esophageal carcinoma in January 1993. He suddenly developed chest pain in October 1994 during hospitlization in the department of ophthalmology for treatment of an occular disease. Hematological test revealed elevation of the white blood cell count to 21, 600 (103/μl) and of CRP to 11.3 (mg/dl). His chest X-ray film demonstrated bilateral pleural effusion and pneumopericardium on the left. Chest CT scans revealed bilateral pleural effusion and pericardial air trapping. Because perforation of the reconstructed gastric tube was suspected to have caused these abnormalities, endoscopic examination of the upper gastric tract was performed. Ulcer with a fistula was detected in the anterior wall of the gastric tube at the vestibular region. Contrast-enhanced X-ray examination of the upper digestive tube revealed a pericardial cavity was delineated. Thus he was diagnosed as having a gastroepicardial fistula, caused by perforating ulcer of the reconstructed gastric tube. At about 3 months after the start of conservative systemic treatment with analgetics, sedatives, antimicrobial agents, a globulin preparation, and antiulcer agents, the perforating fistula was confirmed to be closed on endoscopic examination of the upper digestive tract and contrast-enhanced X-ray examination, and he was allowed to have meals. It is very rare to encounter such a case of gastroepicar-dial fistula caused by an ulcerative lesion in a gastric tube reconstructed following operation for an esophageal carcinoma, and it is much more rare to obtain recovery by conservative therapy. This case is reported with some notes on the relevant literature.
