Abstract
A 54-year-old man was admitted at our hospital with a complaint of sudden anterior chest pain. At 1 year previously he had undergone right transthoracic esophagectomy for cancer followed by reconstruction using a gastric tube through a posterior mediastinal route. Upper gastrointestinal endoscopy confirmed a gastropericardial fistula. He was therefore given emergency intensive proton pump inhibitor together with gastric tube decompression using a nasogastric tube. Transabdominal pericardial drainage was surgically performed through a retrosternal space at 4 days after the onset. On the 22nd day after the drainage operation, upper gastrointestinal endoscopy showed healing of the gastropericardial fistula, and he was discharged on the 38th postoperative day. A gastropericardial fistula in the gastric tube following esophagectomy for cancer could be treated with less-invasive procedures including surgical pericardial drainage. Our procedure may be recommended as initial emergency treatment before more invasive procedures such as gastric tube resection and muscle flap plombage.
Similar content being viewed by others
References
Koide N, Hiraguri M, Nishio A, Hanazaki K, Adachi W, Shikama N, Oguchi M, Maezawa T, Amano J. Ulcer in the gastric tube for esophageal replacement: a comparison of 12 esophageal cancer patients with or without postoperative radiotherapy. J Gastroenterol Hepatol. 2001;16:137–41.
Mori N, Fujita H, Sueyoshi S, Aoyama Y, Yanagawa T, Shirouzu K. Helicobacter pylori infection influences the acidity in the gastric tube as an esophageal substitute after esophagectomy. Dis Esophagus. 2007;20:333–40.
Uchida Y, Tomonari K, Murakami S, Hadama T, Shibata O, Shirabe J. Occurrence of peptic ulcer in the gastric tube used for esophageal replacement in adults. Jpn J Surg. 1987;17:190–4.
Motoyama S, Saito R, Kitamura M, Suzuki H, Nakamura M, Okuyama M, Imano H, Inoue Y, Ogawa J. Prospective endoscopic follow-up results of reconstructed gastric tube. Hepatogastroenterology. 2003;50(51):666–9.
Shima I, Kakegawa T, Fujita H, Yamana H, Shirouzu G, Minami T, Toh Y, Nishida H, Sueyoshi S. Gastropericardial and gastrobrachiocephalic vein fistulae caused by penetrating ulcers in a gastric pedicle following esophageal cancer resection: a case report. Jpn J Surg. 1991;21:96–9.
Matsubara T. Purulent pneumopericarditis due to ulcer of the retrosternal stomach roll after esophagectomy. Eur J Cardiothorac Surg. 2002;22(6):1007.
Schouten van der velden AP, Ruers TJM, Bonenkamp JJ. A cardiogastric fistula after gastric tube interposition. A case report and review of literature. J Surg Oncol. 2007;95(1):79–82.
Kato T, Mori T, Niibori K. A case of gastropericardial fistula of a gastric tube after esophagectomy: a case report and review. World J Emerg Surg. 2010;5:20.
Yamaguchi H, Kato M, Tada N, Murono K, Ishigami H, Kaisaki S, Kitayama J, Nagawa H. Gastropericardial fistula resulting from ulcerative perforation of the reconstructed gastric tube after surgery for esophageal cancer. Esophagus. 2011;8:137–41.
Kim WJ, Choi EJ, Oh YW, Kim KT, Kim CW. Gastropericardial fistula-induced pyopneumopericardium after esophagectomy with esophagogastrostomy. Ann Thorac Surg. 2011;91:e10–1.
Gutschow C, Collard JM, Romagnoli R, Salizzoni M, Holscher A. Denervated stomach as an esophageal substitute recovers intraluminal acidity with time. Ann Surg. 2001;233:509–14.
Fok M, Sham JS, Choy D, Cheng SW, Wong J. Postoperative radiotherapy for carcinoma of the esophagus: a prospective, randomized controlled study. Surgery. 1993;113:138–47.
Ubukata H, Nakachi T, Tabuchi T, Nagata H, Takerura A, Shimazaki J, Konishi S, Tabuchi T. Gastric tube perforation after esophagectomy for esophageal cancer. Surg Today. 2011;41:612–9.
Asaka M, Kato M, Takahashi S, Fukuda Y, Sugiyama T, Ota H, Uemura N, Murakami K, Satoh K, Sugano K. Guidelines for the management of Helicobacter pylori infection in Japan: 2009 revised edition. Helicobacter. 2010;15:1–20.
Chey WD, Wong BCY. American college of gastroenterology guideline on the management of Helicobacter pylori infection. Am J Gastroenterol. 2007;102:1808–25.
Ethical Statement
This article does not contain any studies with human or animal subjects performed by any of the authors.
Conflict of interest
There are no financial or other relations that could lead to conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Mori, N., Fujita, H., Tanaka, T. et al. Gastropericardial fistula in the gastric tube after esophagectomy for cancer. Esophagus 12, 272–276 (2015). https://doi.org/10.1007/s10388-014-0438-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10388-014-0438-4