Published online May 16, 2022. doi: 10.12998/wjcc.v10.i14.4580
Peer-review started: October 9, 2021
First decision: January 11, 2022
Revised: January 16, 2022
Accepted: March 25, 2022
Article in press: March 25, 2022
Published online: May 16, 2022
Esophagojejunal anastomotic leakage (EJAL) is a serious and potentially crucial complication of total gastrectomy and represents the major cause of postoperative death, with a mortality rate of up to 50%. However, treatment remains challenging and controversial. We report here the case of a patient whose intrathoracic EJAL was successfully treated with computer tomography (CT)-guided negative pressure drainage treatment.
A 69-year-old male patient complained of difficulty swallowing within the last six months. He was diagnosed with esophagogastric junction carcinoma, Siewert II, cT3N0M0 stage II. Total gastrectomy and Roux-en-Y esophagojejunostomy were performed. High fever, left chest pain and dyspnea appeared on postoperative day 5, and EJAL was confirmed by CT, gastroscopy and oral blue-dimethylene tests. Conservative treatment measures were applied immediately, including antibiotics, nasojejunal tubes, and repeated thoracic puncture and drainage under ultrasound guidance. However, without sufficient and effective drainage, the thoracic infection and systemic condition continued to deteriorate. With the cooperation of multiple departments, percutaneous CT-guided drainage (24 Fr 7 mm) in the thoracic cavity was successfully placed near the anastomotic leakage. Because of continuous negative pressure suction, the infection symptoms were effectively controlled and the general situation gradually recovered. Subsequent follow-up examination showed that the patient was in good condition.
Negative pressure drainage via CT may represent an effective minimally invasive approach to treating intrathoracic EJAL.
Core Tip: Treatment for esophagojejunal anastomotic leakage (EJAL) is still challenging. Conservative approaches treat the symptoms but not the root causes, which usually leads to further disease progression. Due to the great trauma associated with surgical treatment, mortality is significantly increased. Endoscopic treatment has a certain failure rate and requires multiple endoscopic operations, which certain patients cannot tolerate. We presented the first intrathoracic EJAL case treated by computed tomography-guided negative pressure drainage, which may represent an effective minimally invasive approach.