Esophagojejunal Anastomosis Leakage into the Thorax after Total Gastrectomy: A Case Report

Authors
Mingde Zang, Linwei Guo, Jie Zhang, Hong Fu

Affiliations
Department of Gastric Surgery, Fudan University Shanghai Cancer Center, No. 270 Dongan Road, Xuhui 200032, Shanghai, China

Corresponding Author
Prof. Hong Fu (drfh1805@126.com)

Background
Esophagojejunal leakage is one of the most serious complication in gastric surgery for cancer. Leakage from the esophagus of the anastomosis to the thoracic cavity is rare after total gastric surgery through a midline incision in the upper abdomen.

Case presentation
In this report, we describe a 60-year-old man who was diagnosed with an advanced gastric cancer. The preoperative stage of gastric cancer in this patient was cT4N1M0. The patient had diabetes mellitus and a BMI of 28. The patient had chokethroat and gastrointestinal bleeding before the operation. Methylene blue was taken orally on the third day after surgery and did not leak from the abdominal drainage tube. However, after oral administration of methylene blue, the patient's body temperature rose to 38.4℃ at night. Meanwhile, the patient complained of chest discomfort. Chest CT showed significant gas buildup around the anastomosis. A emergency chest CT scan after oral contrast agent was performed revealed that contrast agent was leaking into the left thoracic cavity. Gastroscopy confirmed that there was a 1*1.5cm leak on the esophageal side of the esophagojejunal anastomosis. Nutrition tube was inserted under gastroscopy. The fluid that drains out of the abdominal cavity is always a pale yellow, clear fluid. After nutritional support, blood glucose control, adequate drainage and other comprehensive treatment, the patient began a liquid diet 39 days after surgery. The feeding tube was removed after 45 days.

Conclusion
Leakage from the esophagus of the anastomosis to the thoracic cavity is a rare but severe complication of total gastrectomy. This complication has a certain degree of concealment. The characteristics of peritoneal drainage after total gastric surgery sometimes cannot reflect the status of esophagojejunal anastomosis. Therefore, for patients with gas around the anastomosis after total gastric surgery, the possibility of anastomotic leakage must be considered. Adequate drainage and treatment of underlying diseases, especially diabetes, are important measures to treat anastomotic leakage.