Abstract
We have experienced a case of penetrated ulcer of the reconstructed gastric tube to the pericardium. A 72-year-old man was admitted to the hospital because of palpitation, dyspnea and severe dehydration in April 2006. He had received a subtotal esophagectomy and a retrosternal esophagogastrostomy for carcinoma of the lower intrathoracic esophagus 4 years before this admission. He was treated using antibiotics and infusion. He developed shock and respiratory arrest 8 hours after the admission. AST, ALT, LDH and CK rised and metabolic acidosis developed. Chest CT revealed the air in the pericardial space and pleural effusion. He was treated using vasopressor and compensated metabolic acidosis. But his general condition deteriorated, resulting in death 45 hours after the admission. The autopsy clarified ulcer penetration of the gastric tube to the pericardium, purulent pericarditis and intestinal necrosis. No recurrence of the esophageal cancer was observed. The long axis of ulcer size was 4 cm. The penetration of the reconstructed gastric tube ulcer is a fatal complication after surgery for esophageal cancer. Early diagnosis and treatment of a lesion of a gastric tube is essential in patients complaining of a pectoralgia or chest discomfort after the esophageal surgery.
