Castaño EMD, García FJE, Arana GS, Osoria AG

Language: Spanish
References: 7
Page: 129-132
PDF size: 193.35 Kb.

ABSTRACT

Background: Leakage of the esophagojejunal anastomosis is a severe complication, with an incidence ranging from 4 to 30% and a mortality from 35 to 70%, being more frequent in the cervical anastomosis with a 12.3% incidence. The endoscopic approach represents a significant progress in the treatment of this complication. What was previously a catastrophe, now it can be managed using advanced endoscopic closure techniques such as in this case. Case report: A male, 59 years of age, without chronic degenerative diseases and the main complaint of gastro esophageal reflux, surgically approached 2 years before with a Nissen laparoscopic fundoplication. 48 hours after surgery, an upper GI barium X-Ray was performed, causing chemical peritonitis due to a perforation in the gastroesophageal junction secondary to an inadvertent lesion during the previous surgical procedure. He underwent exploratory laparotomy and a cervical esophagostomy with a proximal gastrectomy and a distal esophagectomy, also a gastrostomy tube was placed. He comes 14 months later for a mechanical esophagojejunal anastomosis through a laparoscopic approach. During his sixth postoperative day, he developed tachycardia. An esophagogram was requested using oral water-soluble contrast, evidencing an on-site leakage of the anastomosis, it is decided to perform an upper endoscopy and placement of a partially covered flexible prosthesis. At the 36th postoperative day, a new esophagogram was performed, this time without evidence of leakage, withdrawing the endoprosthesis and deciding his hospital discharge. Conclusions: Esophagojejunal leakage as well as esophageal perforation, can be managed endoscopically with a favorable outcome. It is important to keep in mind less invasive options in such situations in order to reduce the morbidity and mortality of these patients.

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