Abstract
The patient was a 71-year-old man who underwent subtotal esophagectomy by right thoracotomy with gastric tube reconstruction through retro-sternal route and lymph node dissection of three regions for cancer of the middle thoracic esophagus in 1996. Suture failure occurred after the operation, for that the anastomosed site was removed and jejunal interposition with vascular anastomosis reconstruction was performed between the cervical esophagus and the gastric tube. The patient improved and was discharged from the hospital. After radiation therapy for the tumor remnant at the left main bronchus, he had had uneventful clinical course until December 2012, when he developed a cutaneous fistula and myelitis of the sternum at the precordia where coincided with the location received irradiation. Although a radical operation was scheduled, we preceded the therapy with conservative treatments including drainage of abscess cavity, administration of antibiotics and a proton pump inhibitor, and enteral nutrition. As a result, the fistula gradually improved and he was discharged in March 2013. Thereafter until January 2014 when he died of other disease, he had been free from recurrence of symptoms.
It is frequently reported that cutaneous fistula after operation for esophageal cancer often affects patients who received irradiation therapy and requires surgery for the radical cure. As it appears rare that cutaneous fistula is conservatively cured like in our case, we here present our case.
