Lock JF, Reimer S, Pietryga S, Jakubietz R, Flemming S, Meining A, Germer CT, Seyfried F. Managing esophagocutaneous fistula after secondary gastric pull-up: A case report. World J Gastroenterol 2021; 27(16): 1841-1846 [PMID: 33967561 DOI: 10.3748/wjg.v27.i16.1841]
Corresponding Author of This Article
Sven Flemming, MD, Academic Research, Senior Research Fellow, Surgeon, Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital Würzburg, Oberdürrbacher Str. 6, Würzburg 97080, Germany. flemming_s@ukw.de
Research Domain of This Article
Surgery
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Apr 28, 2021; 27(16): 1841-1846 Published online Apr 28, 2021. doi: 10.3748/wjg.v27.i16.1841
Managing esophagocutaneous fistula after secondary gastric pull-up: A case report
Johan F Lock, Stanislaus Reimer, Sebastian Pietryga, Rafael Jakubietz, Sven Flemming, Alexander Meining, Christoph-Thomas Germer, Florian Seyfried
Johan F Lock, Sebastian Pietryga, Sven Flemming, Christoph-Thomas Germer, Florian Seyfried, Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital Würzburg, Würzburg 97080, Germany
Stanislaus Reimer, Alexander Meining, Department of Gastroenterology, University Hospital Würzburg, Würzburg 97080, Germany
Rafael Jakubietz, Department of Trauma-, Hand-, Plastic- and Reconstructive Surgery, University Hospital Würzburg, Würzburg 97080, Germany
Author contributions: Lock JF, Pietryga S, Flemming S and Seyfried F wrote the manuscript; Seyfried F led overall treatment; Seyfried F, Lock JF and Jakubietz R performed revisional surgery; Reimer S and Meining A led endoscopic treatment. Lock JF, Pietryga S and Flemming S prepared the figures; Germer CT, Meining A and Jakubietz R supported infrastructure and organizational issues; all authors read and approved the final manuscript.
Informed consent statement: A written consent for publication was obtained from the patient for all potentially identifiable clinical data and accompanying images.
Conflict-of-interest statement: The authors declare that they have no competing interests.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sven Flemming, MD, Academic Research, Senior Research Fellow, Surgeon, Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital Würzburg, Oberdürrbacher Str. 6, Würzburg 97080, Germany. flemming_s@ukw.de
Received: December 21, 2020 Peer-review started: December 21, 2020 First decision: January 23, 2021 Revised: February 5, 2021 Accepted: March 16, 2021 Article in press: March 16, 2021 Published online: April 28, 2021 Processing time: 114 Days and 11.2 Hours
Abstract
BACKGROUND
Gastric pull-up (GPU) procedures may be complicated by leaks, fistulas, or stenoses. These complications are usually managed by endoscopy, but in extreme cases multidisciplinary management including reoperation may be necessary. Here, we report a combined endoscopic and surgical approach to manage a failed secondary GPU procedure.
CASE SUMMARY
A 70-year-old male with treatment-refractory cervical esophagocutaneous fistula with stenotic remnant esophagus after secondary GPU was transferred to our tertiary hospital. Local and systemic infection originating from the infected fistula was resolved by endoscopy. Hence, elective esophageal reconstruction with free-jejunal interposition was performed with no subsequent adverse events.
CONCLUSION
A multidisciplinary approach involving interventional endoscopists and surgeons successfully managed severe complications arising from a cervical esophago-cutaneous fistula after GPU. Endoscopic treatment may have lowered the perioperative risk to promote primary wound healing after free-jejunal graft interposition.
Core Tip: Gastric pull-up (GPU) reconstruction after esophagectomy may be complicated by leaks, fistulas, and stenoses. In such cases, endoscopic interventions, including endoscopic vacuum therapy, stenting, or dilatation, are the corrective treatments of choice, but surgery is preferred when esophageal reconstruction becomes necessary. Here, we report a case of esophageal reconstruction after a secondary GPU procedure by combining endoscopic and surgical techniques to perform subtotal esophageal resection and reconstruction using a free-jejunal graft interposition.
