Journal of Gastric Cancer

The Korean Gastric Cancer Association (대한위암학회)
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Successful Management of a Tracheo-gastric Conduit Fistula after a Three-field Esophagectomy with Combined Sternocleidomastoid Muscle Rotation Flap and Histoacryl Injection Treatment

  • Chung, Yoon Ji (Department of Surgery, College of Medicine, Eunpyeong St. Mary's Hospital, The Catholic University of Korea) ;
  • Kim, Ji Hyun (Department of Surgery, College of Medicine, Eunpyeong St. Mary's Hospital, The Catholic University of Korea) ;
  • Kim, Dong Jin (Department of Surgery, College of Medicine, Eunpyeong St. Mary's Hospital, The Catholic University of Korea) ;
  • Kim, Jin Jo (Department of Surgery, College of Medicine, Eunpyeong St. Mary's Hospital, The Catholic University of Korea)
  • Received : 2020.10.30
  • Accepted : 2020.12.19
  • Published : 2020.12.31
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Abstract

Tracheo-gastric conduit fistula is an extremely rare but severe complication that is difficult to manage. Conservative care, esophageal or tracheal stent placement, or cutaneomuscular flaps have been suggested; however, no definite treatment has been proven. We report a case of tracheo-gastric conduit fistula that occurred after a minimally invasive radical three-field esophagectomy. Following the primary surgery, the diagnosis was made while evaluating the patient's frequent aspiration and coughing. Conservative management failed, and a surgical correction was undertaken to identify the multifocal mucosal defect and exposed tracheal ring. A sternocleidomastoid muscle rotation flap and subsequent Histoacryl injection into the remaining fistula were performed, and the fistula was successfully managed.

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References

  1. Arimoto J, Hatada A, Kawago M, Nishimura O, Maebeya S, Okamura Y. Closure of esophagotracheal fistula after esophagectomy for esophageal cancer. Gen Thorac Cardiovasc Surg 2015;63:636-639. https://doi.org/10.1007/s11748-015-0537-8
  2. Schweigert M, Dubecz A, Beron M, Muschweck H, Stein HJ. Management of anastomotic leakageinduced tracheobronchial fistula following oesophagectomy: the role of endoscopic stent insertion. Eur J Cardiothorac Surg 2012;41:e74-e80. https://doi.org/10.1093/ejcts/ezr328
  3. Zhang Y. Epidemiology of esophageal cancer. World J Gastroenterol 2013;19:5598-5606. https://doi.org/10.3748/wjg.v19.i34.5598
  4. Flanagan JC, Batz R, Saboo SS, Nordeck SM, Abbara S, Kernstine K, et al. Esophagectomy and gastric pull-through procedures: surgical techniques, imaging features, and potential complications. Radiographics 2016;36:107-121. https://doi.org/10.1148/rg.2016150126
  5. Schieman C, Wigle DA, Deschamps C, Nichols Iii FC, Cassivi SD, Shen KR, et al. Patterns of operative mortality following esophagectomy. Dis Esophagus 2012;25:645-651. https://doi.org/10.1111/j.1442-2050.2011.01304.x
  6. Low DE, Alderson D, Cecconello I, Chang AC, Darling GE, DʼJourno XB, et al. International consensus on standardization of data collection for complications associated with esophagectomy: Esophagectomy Complications Consensus Group (ECCG). Ann Surg 2015;262:286-294. https://doi.org/10.1097/SLA.0000000000001098
  7. Lerut T, Coosemans W, Decker G, De Leyn P, Nafteux P, van Raemdonck D. Anastomotic complications after esophagectomy. Dig Surg 2002;19:92-98. https://doi.org/10.1159/000052018
  8. Yasuda T, Sugimura K, Yamasaki M, Miyata H, Motoori M, Yano M, et al. Ten cases of gastrotracheobronchial fistula: a serious complication after esophagectomy and reconstruction using posterior mediastinal gastric tube. Dis Esophagus 2012;25:687-693. https://doi.org/10.1111/j.1442-2050.2011.01309.x
  9. Kauer WK, Stein HJ, Dittler HJ, Siewert JR. Stent implantation as a treatment option in patients with thoracic anastomotic leaks after esophagectomy. Surg Endosc 2008;22:50-53. https://doi.org/10.1007/s00464-007-9504-5
  10. Boyd M, Rubio E. The utility of stenting in the treatment of airway gastric fistula after esophagectomy for esophageal cancer. J Bronchology Interv Pulmonol 2012;19:232-236. https://doi.org/10.1097/LBR.0b013e3182618948
  11. Balakrishnan A, Tapias L, Wright CD, Lanuti MX, Gaissert HA, Mathisen DJ, et al. Surgical management of post-esophagectomy tracheo-bronchial-esophageal fistula. Ann Thorac Surg 2018;106:1640-1646. https://doi.org/10.1016/j.athoracsur.2018.06.076
  12. Honda Y, Taira A, Hirai A, Kuroda K, Ichiki Y, Tanaka F. Novel technique to repair a bronchopleural fistula after esophagectomy using wide intercostal muscle flap fixed by azygos vein and bronchus: a case report. Surg Case Rep 2020;6:183. https://doi.org/10.1186/s40792-020-00908-8
  13. Wang C, Yang X, Zhao J, Chen Q. Postesophagectomy airway-gastric fistula successfully treated with subcutaneous fascia flap, tracheal reconstruction, and gastric fistula drainage: a case report and literature review. J Cancer Res Ther 2016;12 Suppl:C225-C227.
  14. Schneider G, Otto K. In vitro and in vivo studies on the use of Histoacryl(®) as a soft tissue glue. Eur Arch Otorhinolaryngol 2012;269:1783-1789. https://doi.org/10.1007/s00405-011-1868-4
  15. Al-Hillawi L, Wong T, Tritto G, Berry PA. Pitfalls in histoacryl glue injection therapy for oesophageal, gastric and ectopic varices: a review. World J Gastrointest Surg 2016;8:729-734. https://doi.org/10.4240/wjgs.v8.i11.729
  16. Tzifa KT, Maxwell EL, Chait P, James AL, Forte V, Ein SH, et al. Endoscopic treatment of congenital H-Type and recurrent tracheoesophageal fistula with electrocautery and histoacryl glue. Int J Pediatr Otorhinolaryngol 2006;70:925-930. https://doi.org/10.1016/j.ijporl.2005.10.017
  17. Yoon JH, Lee HL, Lee OY, Yoon BC, Choi HS, Hahm JS, et al. Endoscopic treatment of recurrent congenital tracheoesophageal fistula with histoacryl glue via the esophagus. Gastrointest Endosc 2009;69:1394-1396. https://doi.org/10.1016/j.gie.2008.08.022
  18. Pinsker N, Papoulas M, Sodergren M, Harrison P, Heaton N, Menon K. Successful endoscopic management of a persistent bronchobiliary fistula with Histoacryl®/Lipiodol® mixture. Ann R Coll Surg Engl 2018;100:e73-e77. https://doi.org/10.1308/rcsann.2018.0026
  19. Ojima T, Nakamura M, Nakamori M, Katsuda M, Hayata K, Tsuji T, et al. Endoscopic treatment of esophageal fistulas after esophagectomy with injection of an alpha-cyanoacrylate monomer: a phase II study. Endosc Int Open 2018;6:E1093-E1099. https://doi.org/10.1055/a-0581-9005