Abstract
A 64-year-old man underwent a transthoracic esophagectomy for thoracic esophageal carcinoma. Reconstruction of the alimentary tract was done using an ileocolonic conduit via a posterior mediastinal route because the patient had previously had a distal gastrectomy. The postoperative course was complicated by intractable pneumonia. On the 43rd postoperative day, the patient suddenly developed severe respiratory failure, and bronchoscopy revealed a fistula between the reconstructed conduit and the right main bronchus. Due to the patient's rapid respiratory function deterioration, emergent disconnection of the previous gastrojejunostomy was carried out to prevent bile reflux into the tracheobronchial tree. After this operation, he was in fair condition and was managed conservatively with enteral feeding for about 6 months. On the 176th day after the second surgery, direct closure and repair of the fistula were attempted. However, it had to be abandoned because of the presence of severe adhesions and scar formation. Eventually, on the 224th day after the second surgery, an antesternal jejunal reconstruction was performed while the ileocolonic conduit was left in the mediastinum. The patient is alive 4 years after the last operation with neither complications related to the fistula nor signs of cancer recurrence. Prompt disconnection along with elective reconstruction of the digestive tract appears to be an effective treatment strategy for patients with a broncho-enteric fistula after esophagectomy.
