Successful Salvage and Management of Delayed Gastric Conduit Disruption after Ivor-Lewis Esophagectomy
Natalie Ceballos, MD, Syed S. Razi, MD, Mark I. Block, MD, Francisco Tarrazzi, MD.
Memorial Healthcare System, Pembroke Pines, FL, USA.
Background: Gastric conduit disruption after Ivor-Lewis Esophagectomy is an exceedingly rare complication. Management depends on the timing, etiology, conduit viability and severity of leakage and typically requires interventional drain placement with or without conduit resection and cervical esophagostomy. We aim to review a challenging salvage case of delayed gastric conduit disruption eighteen months after minimally invasive esophagectomy (MIE).
Methods: We present a case of a 64 year old male with T2N0 distal esophageal adenocarcinoma who underwent MIE after neoadjuvant chemoradiotherapy. Eighteen months after MIE, patient developed a large pre-pyloric peptic ulcer resulting in gastric outlet obstruction with multiple ensuing complications, as follows: 1) gastric conduit disruption, 2) pulmonary arterial branch bleeding into Eloesser Flap cavity, and 3) persistent gastrocutaneous fistula.
Results: Initial management strategy for conduit disruption included source control with esophageal stent placement and thoracic drainage. Subsequent operations included pyloroplasty, tube pharyngostomy, Eloesser flap creation and repair with omental flap transposition. On four years follow up, the gastric conduit is successfully salvaged with patient tolerating regular diet and disruption site walled off with thick scar and persistent small gastrocutaneous fistula managed with daily dressing changes.
Conclusions: We present a rare case of delayed gastric conduit disruption after MIE resulting in multiple complications managed with prompt and innovative treatment plans resulting in salvage of the gastric conduit and preserved quality of life.
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