TWO-STAGED APPROACH FOR MANAGEMENT OF A COMPLEX INTRA-THORACIC ESOPHAGOGASTRIC ANASTOMOTIC DEHISCENCE

Aims Intra-thoracic anastomotic dehiscence after esophagectomy is a life-threatening complication. Interventional endoscopy plays a key role in managing such adverse events with lower morbidity.

Methods

Case report A 73-year-old female underwent Ivor Lewis esophagectomy for an adenocarcinoma of esophagogastric junction (yPT1aN0). Ten days later, she developed sepsis. Thoracic CT-scan revealed a posterior dehiscence of the intra-thoracic esophagogastric anastomosis and right hydropneumothorax. Broad spectrum antibiotics were initiated. Emergent esophagogastroscopy revealed a 20mm dehiscence of the gastroesophageal anastomosis involving 50% of the circumference with a local abscess adjacent to it. Internal drainage with three 10Fr 5cm plastic double-pigtail stents was performed followed by right thoracic drainage. The patient improved and twelve days later, endoscopy was repeated. The plastic stents were removed, and endoscopy confirmed the extensive dehiscence of the esophagogastric anastomosis communicating with two cavities measuring 6 × 3cm and 4 × 2cm in the mediastinum, filled with necrotic tissue. After endoscopic debridement and lavage of the cavities with saline solution, a partially covered metallic stent (Hanarostent^Ò 20/26 × 100mm) was placed along with a naso-enteric feeding tube. The patient improved and antibiotics were stopped 2 weeks later. The stent was removed 2 months later. The dehiscence had completely closed due to healing by secondary intention. She remains well after 9 months of follow-up.

Fig. 1

Conclusions This case highlights the usefulness of a two-staged sequential approach in the management of upper digestive anastomotic dehiscence.

Publication History

Article published online:
14 April 2022