Abstract
A 55-year-old man who was diagnosed as having gastric cancer by upper gastrointestinal endoscopy for close examination of cholecystolithiasis underwent total gastrectomy with Roux-en-Y reconstruction in our department. On the 4th postoperative day he developed high fever, tachycardia, and dyspnea. Chest x-ray examination performed on the 5th postoperative day revealed bilateral pleural effusion and mediastinal free air. Trocars placed into the both thoracic cavities discharged a mixture of purulent fluid and intestinal juice. Fluoroscopy of the gut revealed major leakage at the esophagojejunal anastomosis and leakage of contrast medium to the mediastinum and both thoracic cavities ; but no leakage to the abdominal cavity was seen. Sustained aspiration with the thoracic drainage, lavage of the thoracic cavity, and tracheal intubation for artificial respiration were started, and intensive treatment was performed. Gastrointestinal fluoroscopy conducted on the 30th postoperative day showed disappearance of the leakage and on the 35th postoperative day extubation became possible. Taking meals was started. No recurrence of the symptoms had occurred and the patient was discharged from the hospital on the 120th postoperative day. We have experienced a patient presented with mediastinitis and bilateral pleural empyema due to leakage of contrast medium to the mediastinum and bilateral thoracic cavities following esophagojejunal anastomotic leakage after total gastrectomy. Since similar case reports have been few, we here present the case together with a review of the literature.
