Fluoroscopically guided nose tube drainage of mediastinal abscesses in post-operative gastro-oesophageal anastomotic leakage

Abstract

Objective: The aim of this study was to retrospectively evaluate the technical success rates and clinical effectiveness of fluoroscopically guided nose tube drainage of mediastinal abscesses and a nasojejunum feeding tube in post-operative gastro-oesophageal anastomotic leakage (GEAL).

Methods: From January 2006 to June 2011, 18 cases of post-operative GEAL with mediastinal abscesses after oesophagectomy with intrathoracic oesophagogastric anastomotic procedures for oesophageal and cardiac carcinoma were treated by insertion of a nose drainage tube and nasojejunum feeding tube under fluoroscopic guidance. We evaluated the feasibility of two-tube insertion to facilitate leakage site closure and complete resolution of the abscess, and the patients' nutritional benefit was also evaluated by checking the serum albumin level between pre- and post-enteral feeding via the feeding tube.

Results: The two tubes were placed successfully under fluoroscopic guidance in 18 patients (100%). The procedure time for two-tube insertion ranged from 20 to 40 min (mean 30 min). 17 patients (94%) achieved leakage site closure after two-tube insertion and had a good tolerance of two tubes in the nasal cavity. The serum albumin level was significant, increased from pre-enteral feeding (2.49 ± 0.42 g dl(-1)) to the post-enteral feeding (3.58 ± 0.47 g dl(-1)) via the feeding tube (p<0.001). The duration of follow-up ranged from 1 to 49 months (mean 19 months).

Conclusion: The insertion of nose tube drainage and a nasojejunum feeding tube under fluoroscopic guidance is safe, and it provides effective relief from mediastinal abscesses in GEAL after oesophagectomy. Moreover, our findings indicate that two-tube insertion may be used as a selective procedure to treat mediastinal abscesses in post-operative GEAL. Advances in knowledge Directive drainage of mediastinal abscesses in post-operative GEAL may be an effective treatment.

Figure 1

The intrathoracic anastomotic leak was confirmed by CT at 1 week post-operation. The fistula located in the posterior mediastinum (white arrow).

Figure 2

A nose drainage tube (white arrow) was inserted through the fistula with fluoroscopic guidance and the distal tip of the drainage tube was positioned at the bottom of the abscess cavity. A feeding nasojejunum tube (black arrow) was placed during interventional operation for post-operative enteral nutrition supply.

Figure 3

11 days post-operation, the fistula had become smaller; we changed the position of the drainage tube to keep optimum drainage.

Figure 4

The fistula closed on 14 days post-operation. The fistula’s closure was testified by CT and gastrointestinal series.

Figure 5

The clinical success of the operation was confirmed by follow-up CT examination.