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Endoscopic techniques in the management of esophagojejunal dehiscence after total gastrectomy

Open AccessPublished:February 26, 2017DOI:https://doi.org/10.1016/j.vgie.2017.01.019
      Anastomotic dehiscence after upper GI surgery is associated with high morbidity and mortality; however, endoscopy is often used in such treatments.
      • Karl R.C.
      • Schreiber R.
      • Boulware D.
      • et al.
      Factors affecting morbidity, mortality, and survival in patients undergoing Ivor Lewis esophagogastrectomy.
      • Valverde A.
      • Hay J.M.
      • Fingerhut A.
      • et al.
      Manual versus mechanical esophagogastric anastomosis after resection for carcinoma: a controlled trial. French Association for Surgical Research.
      • Dasari B.V.M.
      • Neely D.
      • Kennedy A.
      • et al.
      The role of esophageal stents in the management of esophageal anastomotic leaks and benign esophageal perforations.
      • Hoeppner J.
      • Kulemann B.
      • Seifert G.
      • et al.
      Covered self-expanding stent treatment for anastomotic leakage: outcomes in esophagogastric and esophageal anastomoses.
      • Eubanks S.
      • Edwards C.A.
      • Fearing N.M.
      • et al.
      Use of endoscopic stents to treat anastomotic complications after bariatric surgery.
      • Yimcharoen P.
      • Heneghan H.M.
      • Tariq N.
      • et al.
      Endoscopic stent management of leaks and anastomotic strictures after foregut surgery.
      • van Boeckel P.G.A.
      • Sijbring A.
      • Vleggaar F.P.
      • et al.
      Systematic review: temporary stent placement for benign rupture or anastomotic leak of the oesophagus.
      Endoscopy can provide diversion of enteral flow (stents) and drainage of sepsis (both internally and externally).
      We present the case of an 80-year-old woman who initially presented with a large symptomatic paraesophageal hernia and right-sided colon cancer. She underwent laparoscopic repair of the paraesophageal hernia and concomitant right colectomy. However, she experienced an acute early herniation of the stomach into the mediastinum with gastric outlet obstruction, requiring total gastrectomy with an end-to-side esophagojejunostomy secondary to gastric ischemia.
      Six days after the last operation, she had signs and symptoms of a mediastinal leak, and CT imaging showed a very large posterior mediastinal collection (Fig. 1). Endoscopy demonstrated complete dehiscence and severe sepsis (Fig. 2), which was managed with endoscopic therapy (Video 1, available online at www.VideoGIE.org).
      Figure thumbnail gr1
      Figure 1CT image showing large posterior mediastinal collection about 7.5 × 12 cm in diameter.
      Figure thumbnail gr2
      Figure 2Endoscopic view demonstrating esophagojejunal dehiscence was 100% of the circumference with separation of the bowel ends greater than 8 cm.
      Endoscopic treatment took 66 days and provided complete healing with spontaneous regeneration of the esophagojejunal anastomosis, collapse of the cavity, and control of sepsis (Fig. 3).
      Figure thumbnail gr3
      Figure 3Endoscopic view demonstrating complete mucosal regeneration of esophagojejunostomy anastomosis.

      Disclosure

      All authors disclosed no financial relationships relevant to this publication.

      Supplementary data

      References

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