Abstract
An 83-year-old female underwent low esophagectomy and total gastrectomy for esophageal cancer. After surgery, she was managed conservatively for anastomotic leakage. Forty seven days postoperatively, she vomited blood. Upper gastrointestinal endoscopy showed no focus of bleeding. At fifty two days after the operation, she vomited large amounts of blood and therefore went into hemorrhagic shock. Chest enhanced CT revealed that the descending aorta penetrated into the abscessed cavity where there was anastomotic leakage. We conducted an emergency endovascular repair with a stent graft. She went into cardiopulmonary arrest due to hyperkalemia as a result of massive transfusion during surgery. She was treated by emergency chest compressions by the surgeons. A postoperative CT study revealed a complex deep injury of the liver and hemorrhagic ascites caused by intraoperative cardiopulmonary resuscitation. However, she achieved hemodynamic stability, so she was followed without further surgery. We considered that the liver injury had been caused by either compression which had been performed at an incorrect location because the surgical drape had blocked the view of the patient’s body, by excessive pressure, or a combination of both.
