Intramucosal carbon dioxide partial pressure measurement rescued the reconstructed gastric tube

A 60-year-old male patient with esophageal carcinoma underwent esophagectomy and gastric tube construction with cervical esophagogastrostomy. A tonometer catheter (Tonometrics™ Catheter, TONO-16 F, Datex-Ohmeda, Finland) was placed transnasally into the lumen of the gastric tube just after the gastric tube formation. The catheter was connected to a TONOCAP (Datex Ohmeda) monitor. The intramucosal partial pressure of carbon dioxide (PiCO2) was then measured intermittently. A PiCO2 of 105 mmHg just after the gastric tube formation indicated the possibility of an impaired blood flow in the gastric tube. Reanastomosis of the artery and vein to the gastric tube was performed immediately to improve perfusion. This procedure salvaged the gastric tube and PiCO2 decreased to 43 mmHg at the end of the operation. Subsequently, PiCO2 returned to the normal range. PiCO2 is regularly measured to assess the state of the reconstructed gastric tube during the postoperative period in the intensive care unit (ICU). The clinical course of the patient suggests that measuring PiCO2 using a tonometer catheter is useful to detect any abnormal blood supply to the reconstructed gastric tube not only in the postoperative period in the ICU but also in the intraoperative period.