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. 2021 Apr 15;7(1):95.
doi: 10.1186/s40792-021-01178-8.

A case report of a gastrobronchial fistula and lung abscess caused by leakage from the staple line of a gastric tube after esophagectomy for esophageal cancer

Tohru Nishimura  1 , Chisakou Fuse  2 , Masayuki Akita  2 , Nobuhisa Takase  2 , Eri Maeda  2 , Koichiro Abe  2 , Akihito Kozuki  2 , Kunio Yokoyama  2 , Tomohiro Tanaka  2 , Shinji Kishi  2 , Toshihiko Sakamoto  3 , Tetsuya Sakai  4 , Kunihiko Kaneda  2
Affiliations

A case report of a gastrobronchial fistula and lung abscess caused by leakage from the staple line of a gastric tube after esophagectomy for esophageal cancer

Tohru Nishimura et al. Surg Case Rep. .

Abstract

Background: Gastrobronchial fistulas are rare, but life-threatening, complications of esophagectomy. They are caused by anastomotic leakage and mainly occur around anastomotic sites. In the present paper, we report a rare case of leakage from the staple line of a gastric tube after esophagectomy for esophageal cancer, which was successfully treated using an intercostal muscle flap and lung resection.

Case presentation: A 61-year-old male underwent subtotal esophagectomy with regional lymphadenectomy for esophageal cancer. The sutures along the staple line of the gastric tube failed 11 days after surgery, and a pulmonary abscess was also found on imaging. The abscess did not heal after conservative treatment; therefore, right lower lobectomy, gastrobronchial fistula resection, primary closure, and patching of the leaking portion of the gastric tube with an intercostal muscle flap were performed 9 months after the first operation. The patient's postoperative course was uneventful, and he was discharged on the 354th day.

Conclusions: We experienced a case involving a gastrobronchial fistula caused by leakage from the staple line of a gastric tube and successfully treated it by performing right lower lobectomy and patching the leak with an intercostal muscle flap.

Keywords: Anastomotic leakage; Esophageal cancer; Esophagectomy; Gastrobronchial fistula; Intercostal muscle flap.

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Conflict of interest statement

None to declare.

Figures

Fig. 1
Fig. 1
Imaging examinations of the fistula and pulmonary abscess performed before the conservative treatment. a A CT image showed a cavity with an air bubble on the right side of the gastric staple line. The green arrow indicates the gastric tube, and the red arrowheads show the abscess. b A Gastrografin esophagram showed extravasation into the right side of the thoracic cavity (red arrowheads). c An endoscopic examination confirmed that the fistula was located on the anal side of the anastomotic site. The red arrowheads indicate the fistula
Fig. 2
Fig. 2
Imaging examinations performed after the conservative treatment. a A Gastrografin esophagram showed that the leakage was localized (red arrowhead). b CT showed an abscess as a reduction in permeability localized in the right lung (red arrowheads)
Fig. 3
Fig. 3
Intraoperative images. a The right lower pulmonary lobe was excised, and an intercostal muscle flap was placed over the suture line of the conduit. GT gastric tube, MF muscle flap. b The schema of the surgery is shown
See this image and copyright information in PMC

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