A CASE OF THORACIC EMPYEMA CAUSED BY A RECONSTRUCTED GASTRIC TUBE ULCER PERFORATED INTO THE THORACIC CAVITY AFTER ESOPHAGECTOMY

Abstract

This paper presents a case of thoracic empyema caused by a reconstructed gastric tube ulcer after esophagectomy for esophageal cancer, together with a review of the literature.
The patient was a 55-year-old man, who had undergone total excision of the thoracic esophagus with gastric tube reconstruction through the mediastinum for cancer of the middle intrathoracic esophagus 2 years before admission. This time the patient was seen at the hospital because of the abrupt onset of dyspnea, and was admitted with a diagnosis of right thoracic empyema by a chest x-ray film and a chest CT scan. Following a chest CT scan, upper gastrointestinal series, and endoscopic study after admission, perforation of a huge peptic ulcer at the lower part of gastric tube into the thoracic cavity was diagnosed. The patient was treated with administration of optimal antibiotics and daily lavage and drainage using a chest tube, and at the same time central venous nutrition and nasal feeding were used for the purpose of nutritional improvement. The gastric tube ulcer improved to the cicatrical phase 2 months after admission, when his nutritional state improved and thoracic empyema as well as pneumonia disappeared. The patient was discharged very much improved on the 119th hospital day. It is etiologically inferred that he might have experienced traumatic and physical stress because he suffered from depression after surgery for esophageal cancer and he had undergone another surgery for gallstone and cholecystitis one month before admission; under these conditions medication of NSAID started after the surgery for gallstone facilitated occurrence of ulcer causing perforation.