Anastomotic leakage after esophagectomy possibly caused by compression of the gastric conduit behind the sternoclavicular joint: a report of three cases

Surgical Case Reports

Tsutomu Kumamoto¹  Yoshinori Ishida¹  Tatsuro Nakamura¹  Hisashi Shinohara¹  Yasunori Kurahashi¹  Yudai Hojo¹ 

[1] Department of Gastroenterological Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, 663-8501, Nishinomiya, Hyogo, Japan;

关键词: Esophagectomy;    Anastomotic leakage;    Sternoclavicular joint;    Compression;    Indocyanine green fluorescence imaging;   

DOI  :  10.1186/s40792-021-01250-3

来源: Springer

【 摘 要 】

BackgroundThe narrowness of the thoracic inlet is often a problem in retrosternal reconstruction after esophagectomy. We report here three cases in which compression of the gastric conduit behind the sternoclavicular joint possibly caused anastomotic leakage.Case presentationsThe first case was a 71-year-old man who underwent subtotal esophagectomy for upper esophageal cancer followed by retrosternal reconstruction. On postoperative day 2, he developed septic shock and underwent reoperation because of a necrotic gastric conduit. The tip of the conduit above the manubrium was necrotic due to strangulation as a result of compression by the sternoclavicular joint. The second and third cases were a 50-year-old woman and a 71-year-old man who underwent subtotal esophagectomy for middle and lower esophageal cancer, respectively, followed by retrosternal reconstruction. Despite indocyanine green fluorescence imaging indicating adequate blood flow in both cases, the tip of the conduit appeared pale and congested because of compression by the sternoclavicular joint after anastomosis. Postoperatively, these two patients developed anastomotic leakage that was confirmed endoscopically on the ventral side of the gastric wall that had been pale intraoperatively.ConclusionsWhen performing reconstruction using the retrosternal route after esophagectomy, it is important to ensure that compression by the sternoclavicular joint does not have an adverse impact on blood flow at the tip of the gastric conduit.

【 授权许可】

CC BY