Abstract
We report a case of severe hemorrhagic shock due to ulceration in the reconstructed gastric tube placed posterior to the mediastinum after radical resection for esophageal cancer. The patient is a 72-year-old man who underwent an operation for esophageal cancer on June 1, 1988. After the operation, he was irradiated prophylactically with a total dose of 80 Gy. He showed no sign of recurrence. Three years and seven months after the operation, he suddenly developed hematemesis with hemorrhagic shock. Endoscopy on admission revealed an ulcer with exposed vessels in the reconstructed gastric tube. Hemostasis using endoscopy and balloon tamponade could not control the bleeding. Emergency operations, gastrotomy and direct suture of the ulcer, were performed twice but were unsuccessful. At last the gastric tube was resected transthoracically and cervical esophagocutaneostomy and tube jejunostomy was performed on the third operation. After the operation, his shock improved dramatically. Reconstruction using pedicled colon was performed 6 months later. The pathogenesis of the ulcer was considered to be mucosal damage due to postoperative irradiation and the remaining acid secretion in the gastric tube.
