Published online Aug 16, 2014. doi: 10.12998/wjcc.v2.i8.398
Revised: February 8, 2014
Accepted: June 13, 2014
Published online: August 16, 2014
As patients with carcinoma of the esophagus live longer, complications associated with the use of a gastric conduit are increasing. Ulcers form in the gastric conduit in 6.6% to 19.4% of patients. There are a few reports of perforation of a gastric conduit in the English literature. Almost all of these were associated with serious complications. We report a patient who developed a tension pneumothorax consequent to spontaneous perforation of an ulcer in the gastric conduit 7 years after the index surgery in a patient with carcinoma of the gastroesophageal junction. He responded well to conservative management. Complications related to a gastric conduit can be because of multiple factors. Periodic endoscopic surveillance of gastric conduits should be considered as these are at a higher risk of ulcer formation than a normal stomach. Long term treatment with proton pump inhibitors may decrease complications. There are no guidelines for the treatment of a perforated gastric conduit ulcer and the management should be individualized.
Core tip: We report a patient with a spontaneous perforation of an ulcer in the gastric conduit of a patient who had surgery for carcinoma of the gastroesophageal junction. He responded to conservative management with continuous decompression of the conduit with Ryle’s tube aspiration, proton pump inhibitors and enteral nutrition through a feeding jejunostomy for 4 wk. Periodic endoscopic surveillance should be considered as gastric conduits are at a higher risk of ulcer formation than a normal stomach and management of a perforated gastric conduit ulcer should be individualized.