Successful management of esophagopericardial fistula complicating esophagogastrectomy

An anastomotic leak into the right pleural space developed following esophagogastrectomy for cancer in a 56-year-old patient. Subsequently, a similar fistula occurred into the pericardium. This was managed successfully by a modification of Abbott's T-tube technique, together with a pericardial window, multiple drainage tubes, systemic antibiotics, and hyperalimentation. The anastomotic disruption healed completely, with only minimal narrowing on repeat roentgenograms of the upper gastrointestinal tract. Only four survivors of this rare and highly lethal problem have been previously reported.