Case report

Gastro-tracheal fistula - unusual and life threatening complication after esophagectomy for cancer: a case report

Jane E Nardella¹ , Dirk Van Raemdonck² , Hubert Piessevaux³ , Pierre Deprez³ , Raphaël Droissart¹ , Jean-Pierre Staudt¹ , David Heuker¹ and Etienne van Vyve¹

¹  Department of Surgery, St Jean Hospital, Brussels, Belgium

²  Department of Thoracic Surgery, University Hospital Gasthuisberg, Leuven, Belgium

³  Department of Gastro-Enterology, Cliniques Universitaires St-Luc, Université Catholique Louvain, Brussels, Belgium

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Journal of Cardiothoracic Surgery 2009, 4:69doi:10.1186/1749-8090-4-69

Published:	29 November 2009

Abstract

Background

A gastro-tracheal fistula following esophagectomy for cancer is a rare but potentially lethal complication. We report the successful surgical closure after failed endoscopic treatment, of a gastro-tracheal fistula following esophago-gastrectomy for cancer after induction chemo-radiotherapy.

Case presentation

A 58 year-old male patient presented with a distal third uT3N1 carcinoma of the esophagus. After induction chemo-radiotherapy, he underwent an esophago-gastrectomy with radical lymphadenectomy and reconstruction by gastric pull-up. Immediate postoperative outcome was uneventful. On the 15^th postoperative day however, our patient was readmitted in the Intensive Care Unit with severe bilateral basal pneumonia. Three days later a gastro-tracheal fistula was diagnosed upon gastroscopy and bronchoscopy. His good general condition allowed for an endoscopic primary approach which consisted in the insertion of a covered stent in the trachea along with clipping and glueing of the gastric fistular orifice. Two attempts proved unsuccessful.

Conclusion

After several weeks of conservative measures, surgical re-intervention through a right thoracotomy with transection of the fistula and closure by primary interrupted sutures of both fistular orifices along with intercostal muscle flap interposition led to excellent patient outcome. Oral feeding was started and our patient was discharged.