title: Surgical treatment of intractable cutaneous fistula with osteomyelitis in the neck developed after esophagectomy.
abstract: A case of intractable cutaneous fistula in an esophagogastrostomized region complicated by osteomyelitis is reported. A three-stage operation was performed, and gratifying results were obtained. The patient was a 74-year-old man who received a subtotal esophagectomy and a cervical esophagogastrostomy through a retrosternal approach for advanced esophageal cancer. Following subsequent radiotherapy, the anastomosed region in the neck was found to have been stenosed. Endoscopic balloon dilatation was then performed and perforation of the stenosed region occurred to form an intractable fistula. A chest computed tomography scan revealed osteolysis of the sternum, clavicular head and left first rib. Treatment comprised an initial control of the infective foci including osteomyelitis and, after achieving stabilization of the wounds, the subsequent step of reconstruction. The patient's postoperative course was satisfactory without involvement of any leakage or stenosis of the anastomosed regions, or wound infection. It is considered feasible to cure even a cutaneous fistula in the neck complicated by osteomyelitis, as in the present case, by sufficient control of infection and procedural contrivance.
authors.affiliation: Department of Surgery, Tokyo Women's Medical University Medical Center East, 2-1-10, Nishiogu, Arakawa-ku, Tokyo, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Shimakawa
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Naritaka
authors.forename: Shinichi
authors.initials: S
authors.lastname: Asaka
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Isohata
authors.forename: Minoru
authors.initials: M
authors.lastname: Murayama
authors.forename: Soichi
authors.initials: S
authors.lastname: Konno
authors.forename: Takao
authors.initials: T
authors.lastname: Katsube
authors.forename: Kenji
authors.initials: K
authors.lastname: Ogawa
authors.forename: Hiroko
authors.initials: H
authors.lastname: Ide
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy / Q000601:surgery; D002404:Catheterization / Q000009:adverse effects; D003251:Constriction, Pathologic / Q000209:etiology / Q000601:surgery; D017577:Cutaneous Fistula / Q000209:etiology* / Q000601:surgery; D004938:Esophageal Neoplasms / Q000532:radiotherapy / Q000601:surgery; D016629:Esophagectomy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D009333:Neck; D010019:Osteomyelitis / Q000209:etiology* / Q000601:surgery; D011183:Postoperative Complications; D011878:Radiotherapy; D019651:Plastic Surgery Procedures