Abstract
We report a case of bronchial necrosis after esophagectomy, treated using a percutaneous cardiopulmonary support system (PCPS). The patient was a 63-year-old man who underwent a thoracic esophagectomy with gastric tube reconstruction via the posterior mediastinum route for esophageal cancer. The respiratory condition worsened on postoperative day (POD) 5, following which anastomotic leakage, mediastinal abscess, and necrosis of the right membranous bronchus was diagnosed on POD 7. An emergency operation was performed under the PCPS, with the patient in a state of severe respiratory failure. The esophagogastric anastomosis was divided, and then a cervical esophageal fistula was created. The necrotic portion of the right main bronchus was covered by the omentum adhering to the gastric tube. PCPS use was continued after the operation and changed to veno-venous extracorporeal membrane oxygenation (V-V ECMO) on POD 3. The ECMO system was used until POD 7. The patient could be weaned off mechanical ventilation on POD 77 due to improvement in respiratory status accompanied by granulation of the bronchial necrosis. He was transferred to the previous hospital on POD 118. Bronchial necrosis after esophagectomy is commonly followed by a critical general condition because of concomitant severe respiratory failure ; therefore, a pump oxygenator such as the PCPS or ECMO may be useful in severe respiratory failure during the perioperative period.
