Management of intrathoracic leakage after radical total gastrectomy

Intrathoracic anastomotic leakage resulted from radical total gastrectomy with an end-to-side esophagojejunostomy are exclusively abdominal.

We report the case of a 64-year-old male who underwent radical total gastrectomy and intraabdominal end-to-side esophagojejunostomy for gastric cardiac carcinoma. Anastomotic leakage to the thoracic cavity occurred which was confirmed by contrast radiography 18 days after the operation. The symptoms included coughing and fever, with elevated white blood cells over 10×10(9)/L. Coughing and fever disappeared after successful sealing of the fistulous orifice with an endoscopically placed covered metallic stent with the applications of antibiotics and drainage of the pleural effusion. The patient was recovered and discharged from the hospital approximately two months after the occurrence of the leakage without any symptoms except intermittent esophageal reflux which could be resolved by treatment with cisapride, or by intaking less liquid food. The patient then received 4 cycles of adjuvant chemotherapy with regimen of FOLFOX4 (fluorouracil, leucovorin and oxaliplatin). Unfortunately, he died of a disease- or treatment- unrelated accidence 5 months after the discharge.

The thorough drainage combined with antibiotic treatment is able to eliminate empyema without the need for a specific thoracoscopy or thoracic surgery for patients with intrathoracic leakage.