Endoscopic Vacuum Therapy for Anastomotic Leakage After Distal Gastrectomy in a Renal Transplant Patient: A Case Study

Abstract

BACKGROUND Since the late 2000's, endoscopic vacuum therapy (EVT) has gained popularity in the management of anastomotic leakage (AL) of the upper gastrointestinal (GI) tract due to its safety and efficacy. This report describes a 66-year-old male renal transplant patient with an AL following distal gastrectomy for gastric adenocarcinoma and was treated with EVT. CASE REPORT We present the case of a 66-year-old transplant patient with multiple comorbidities who developed AL following distal gastrectomy for gastric adenocarcinoma. Before the scheduled operation, he had been deemed at high risk for AL due to immunosuppression, as well as his history of end-stage renal disease and multiple abdominal surgeries. After an initial failed attempt to treat the AL surgically, he became the first person to be treated with a self-assembled EVT in our hospital. He was successfully treated with EVT and was ultimately safely discharged. Also, 30 days after discharge, he did not report any discomfort or express any problems with oral intake of food, as supported by the findings of a follow-up endoscopy. CONCLUSIONS EVT is a reproducible technique, which when performed by experienced practitioners, remains effective even in the absence of prior experience with the procedure or even procedure-specific equipment. The technique shows promising outcomes in the management of AL and this case highlights the technique's effectiveness even in a patient with compromised wound healing in the presence of a hostile abdomen.

Figure 1

Axial and sagittal view of computed tomography scan depicting the stomach pouch filled with oral contrast at the level of the anastomosis. Red arrow points the extraluminal air around the drain tube. No oral contrast leakage can be seen.

Figure 2

Fluoroscopy upper-gastrointestinal series with oral contrast, revealing leakage of contrast to the left (red arrow).

Figure 3

Self-assembled endo-vacuum device. A polyurethane sponge was sutured at the tip of a 14Fr nasogastric tube, which was placed intra-luminally, sealing the defect of the anastomotic leakage.

Figure 4

Endoscopic images showing the initial size of the defect at the level of the anastomosis with a visible drain (red arrow), showing results after the first sponge replacement and the final closure of the defect with formation of granulated tissue.