A Case of Conservatively Treated Gastropericardial Fistula due to a Reconstructed Gastric Tube Ulcer after Esophagectomy for Cancer

Abstract

The case involved a 58-year-old man who presented with persistent left chest pain and dyspnea and underwent thoracoscopic subtotal esophagectomy and retrosternal gastric tube reconstruction for esophageal cancer in 2013. In January 2018, he developed pneumothorax and had been prescribed nonsteroidal anti-inflammatory drugs (NSAIDs) until March 2018 when he visited the ambulatory care for persistent chest pain. He was hospitalized with a diagnosis of cardiac tamponade, and percutaneous cardiovascular drainage was performed on the 2^nd hospital day. The patient was also suspected of having a gastrointestinal fistula for which he underwent upper gastrointestinal endoscopy on the 9^th hospital day. A huge ulcer was observed on the anterior/posterior wall of the lower part of gastric tube and a big fistula on the bottom of the ulcer on the posterior wall, and a cardiac drain tube was recognized within the fistula. The fistula on the posterior wall was drained using naso-esophageal extraluminal drainage (NEED). Furthermore, percutaneous endoscopic gastrostomy was performed and the fistula was healed conservatively on the 58^th hospital day. A gastropericardiac fistula caused by gastric tube ulcer can be a fatal complication after esophageal cancer surgery ; thus, appropriate treatment is critical. In a review of the literature, this is the first case report of gastropericardiac fistula after esophagectomy followed by gastric tube reconstruction, which has been conservatively cured by NEED and enteral nutrition.