A case of a gastroepicardial fistula due to perforating ulcer of the reconstructed gastric tube after surgery for esophageal cancer

Abstract

The patient was a 66–year–old man who underwent subtotal esophagectomy and retrosternal route esophagogastric tube anastmosis at the cervical region for esophageal cancer in January 2001. In January 2006, he was seen at the hospital because of general fatigue and admitted with a diagnosis of pericardial effusion. By endoscopic study and contrast–enhanced X–ray examination he was diagnosed as having a gastroepicardial fistula caused by perforating ulcer of the reconstructed gastric tube. He was treated with fasting, protonpump inhibitor, antibiotics, and percutaneous drainage in the pericardial space. The function of the heart was kept good and the infection was well controlled. At about one month after the initiation of conservative systemic treatment, the perforating fistula was confirmed to be closed on endoscopic and contrast–enhanced X–ray examinations.
With recent progression in the treatment of esophageal cancer, long–term survivors after operation have been increasing and ulcer of the reconstructed gastric tube has not been uncommon. However, cases of ulcer of the reconstructed gastric tube due to a gastroepicardial fistula, especially cured by conservative therapy, are relatively rare. So we report this case with some notes on the relevant literature.