Abstract
The case involved a 59-year-old man who underwent right trans-thoraco-abdominal subtotal esophagectomy and gastric tube reconstruction via retro-sternal route about 4 years and 2 months earlier. There were previous histories of chronic renal failure and oral intake of aspirin for sequela of cerebral infarction. He had been on oral intake of proton pump inhibitor(PPI) and recurrence free. He had received yearly esophagogastroduodenoscopy (EGD), and no ulcer was found at the previous EGD conducted 6 months previously. He had noticed tarry stool since 10 days earlier, and was brought into our hospital by ambulance because of severe pain from the anterior thoracic region to the back. Close exploration offered the diagnosis of perforation of an ulcer in the gastric tube into the pericardium. On the same day, we performed pericardial drainage that resulted in symptomatic remission. EGD performed on the 16th hospital day confirmed absence of perforation findings and oral PPI regimen was resumed. He was discharged from the hospital to home on the 22nd hospital day. The patient had undergone periodic EGD during the PPI regimen and showed Helicobacter pylori antigen negative. This case suggests that there is a possibility of causing ulcer at the gastric tube even possible prophylactic strategies are employed. Not the least cases followed a fatal course have been reported so that prompt pericardial drainage may be mandatary if it occurs.
