Emergency escape surgery for a gastro-bronchial fistula with respiratory failure that developed after esophagectomy.
A gastro-bronchial fistula (GBF) is a rare complication after esophageal reconstruction using a gastric tube, but it can cause severe pneumonia, and the surgical procedure is challenging. We herein describe a patient who was successfully managed using a two-stage operation for a GBF. Because the patient had life-threatening pneumonia and respiratory failure caused by the GBF, we first transected the duodenum, established a cervical esophagostomy and gastrostomy and placed a decompression catheter in the gastric tube without a thoracotomy. The patient recovered from pneumonia after the resolution of the salivary inflow and digestive juice reflux into the lungs through the GBF. Two months later, an esophageal bypass was achieved by reconstructing the esophagus using a long segment of pedicled jejunum. The patient was discharged 38 days thereafter. Appropriate treatment for GBF should be tailored to individual patients based on their current status and disease severity.
Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan, x06357@yahoo.co.jp.
Yuta
Y
Ibuki
Yoichi
Y
Hamai
Jun
J
Hihara
Junya
J
Taomoto
Ichiko
I
Kishimoto
Yoshihiro
Y
Miyata
Morihito
M
Okada
D001983:Bronchial Fistula / Q000209:etiology / Q000601:surgery*; D004386:Duodenum / Q000601:surgery; D004630:Emergencies; D004938:Esophageal Neoplasms / Q000601:surgery; D016629:Esophagectomy; D004946:Esophagostomy; D005747:Gastric Fistula / Q000209:etiology / Q000601:surgery*; D005774:Gastrostomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000209:etiology / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery*; D019651:Plastic Surgery Procedures; D012131:Respiratory Insufficiency / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome