title: Benign post-esophagectomy gastrocardiac fistula.
abstract: The development of a gastrocardiac fistula is a rare complication following retrosternal gastric conduit creation. We report a case of a 64-year-old male who presented three years after esophagectomy with massive hematemesis. A fistulous connection between his gastric conduit and right ventricle was identified and successfully treated. Although the patient had an atypical presentation and lacked most of the commonly cited risk factors, the combination of peptic ulcer disease and Candida overgrowth resulted in the formation of a gastrocardiac fistula. Adherence to treatment principles including prompt surgical intervention, adequate coverage of the repair, and antimicrobial therapy against Candida species provides the highest likelihood of success in addressing this potentially lethal disease process.
authors.affiliation: Division of General Surgery, Department of Surgery, William Beaumont Hospitals, Royal Oak, MI 48073, USA.
authors.forename: Patricia
authors.initials: P
authors.lastname: Pentiak
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Seder
authors.forename: Gary W
authors.initials: GW
authors.lastname: Chmielewski
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Welsh
mesh_terms: D002177:Candidiasis / Q000150:complications; D004939:Esophageal Perforation / Q000601:surgery; D016629:Esophagectomy / Q000009:adverse effects*; D017809:Fatal Outcome; D005402:Fistula / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D005747:Gastric Fistula / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006331:Heart Diseases / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D006396:Hematemesis / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D012086:Reoperation; D013276:Stomach Ulcer / Q000150:complications / Q000188:drug therapy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D054328:Proton Pump Inhibitors