Abstract
We treated a 66-year-old man who had previously undergone a total esophagectomy with reconstruction of the gastric tube through the posterior mediastinal route and had received a permanent tracheostoma for esophageal cancer in 1995. In 2007, he suffered hematemesis and saburra was expectorated from the tracheostoma. On the day of admission, massive hematemesis occurred at midnight, and the patient immediately underwent emergency surgery, during which direct closure of the reconstructed gastric tube tracheal fistula and suturing hemostasis of the gastric tube ulcer were performed. During surgery, the brachiocephalic artery was injured and hemostatic suturing with a felt pledget was added. However, bleeding from the wound occurred 9 days postoperatively and re-operation was performed. In the second operation, a femoro-axillar arterial bypass was first performed with a Gore-Tex® graft, then the brachiocephalic artery was closed at its origin and bifurcation was done. However, after surgery, the wound remained infected and hospitalization was extended but the bypass graft was effective, and neither rebleeding nor cerebral circulatory insufficiency occurred. To the best of our knowledge this is the first known report of extra-anatomical bypass surgery for bleeding after treatment for esophageal cancer.
