2025 Volume 45 Issue 1 Pages 41-45
A 75-year-old man presented to us with the chief complaint of back pain while receiving multidisciplinary treatment (including pulmonary resection, cancer immunotherapy, and chemotherapy) for postoperative pulmonary metastases and lymph node recurrence that developed following esophagectomy with gastric tube reconstruction via the posterior mediastinal route performed 4 years ago for thoracic esophageal cancer. CT examination showed thickening of the ascending aortic wall. He was admitted to the hospital with suspected ascending aortitis and initiated on antibiotic treatment. However, there was no improvement, and a repeat CT revealed the presence of free gas within the pericardium, which led to the suspicion of a fistula between the gastric tube and the pericardium. We performed emergency surgery for the gastric tube ulcer penetrating the pericardium, with ligament teres hepatis and omental patch closure undertaken via an abdominal-transhiatal approach, followed by pericardial drainage via a median sternotomy. The patient died on postoperative day 48 due to liver failure. However, despite the severity of his condition, he was able to resume oral intake by postoperative day 21. Surgical pericardial drainage is critical in such cases, and a direct approach to the perforation site should be adopted to enable suture closure and filling whenever feasible.
