A SUCCESSFULLY SAVED CASE OF ULCER OF RECONSTRUCTED GASTRIC TUBE PERFORATED TO THE LEFT SUBCLAVIAN ARTERY 5 YEARS AFTER OPERATION FOR ESOPHAGEAL CANCER

Abstract

Perforation of ulcer of the reconstructed gastric tube to vessels after operation for esophageal cancer is so rate that only two cases have been reported in Japan. We have experienced a case of perforated ulcer of reconstructed gastric tube to the left subclavian artery causing massive hematemesis. This paper presents the case with some bibliographical comments.
A 58-year-old man was admitted to the hospital because of hematemesis. Previous histories disclosed that he underwent a right thoracolaparotomic subtotal esophagectomy and retrosternal esophagogastroanastomosis for a cancer of the middle intrathoracic esophagus in August, 1992; and he had been healthy for 5 years and 11 months after postoperative irradiation until this admission. The patient repeated massive hematemesis and fell in shock state. An emergency operation was performed. When the gastric tube was examined under a median sternotomy, arterial projective bleeding from a small ulcer just beneath the esophagogastoanastomosed site was confirmed. Hemostasis of the bleeding site was attained by simple suture, the reconstructed tube was pulled out, and an esophagostomy and a jejunostomy were performed. Postoperative angiography demonstrated that the perforated organ by ulcer of the reconstructed gastric tube was the left subclavian artery.