A Case of Anastomotic Failure after Esophagogastric Junctional Cancer Surgery Treated with a W-ED Tube

Abstract

A 72-year-old man underwent open total gastrectomy with transhiatal lower esophagectomy followed by Roux-en-Y reconstruction for cStage III esophagogastric junctional cancer of Siewert type 3. He developed respiratory failure due to aspiration pneumonia caused by intestinal paralysis after surgery, and ventilator management was started on postoperative day (POD) 2. Computed tomography on POD 15 and endoscopy on POD 21 showed anastomotic failure at the esophageal jejunal anastomosis, and conservative treatment was selected. On POD 23, a W-ED (double elementary diet) tube was placed to promote healing, and enteral nutrition was started in addition to intestinal decompression, and the systemic inflammation improved rapidly. In conditions where an abscess outside the gastrointestinal tract can be drained, management by a W-ED tube is a useful treatment option, allowing simultaneous gastrointestinal decompression and enteral nutrition with a single device.