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Delayed leaks and fistulas after esophagogastrectomy: radiologic evaluation
M M Anbari1, M S Levine, R B Cohen
1Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia 19104.
AJR. American Journal of Roentgenology
|June 1, 1993
Summary
Late esophagogastric anastomotic leaks and fistulas can occur after esophagectomy. While some are asymptomatic, others may present as serious gastropleural or gastrobronchial fistulas requiring surgical repair.
Area of Science:
- Gastroenterology
- Radiology
- Surgical Oncology
Background:
- Esophagogastric anastomotic breakdown is a known early complication of esophagectomy.
- Late-onset anastomotic leaks and fistulas (occurring >1 month post-surgery) are less recognized.
Purpose of the Study:
- To determine the radiologic appearance of late anastomotic leaks and fistulas.
- To assess the clinical significance of these late-onset complications following esophagectomy.
Main Methods:
- Retrospective review of radiology records from 1985-1991.
- Analysis of upper gastrointestinal contrast studies in 37 patients post-esophagectomy.
Main Results:
- Six patients (16%) presented with late anastomotic leaks or fistulas.
- Findings included asymptomatic blind-ending tracks and symptomatic gastropleural/gastrobronchial fistulas.
- No leaks or fistulas were associated with recurrent tumor.
Conclusions:
- Late anastomotic leaks and fistulas are detectable via contrast studies more than one month after esophagectomy.
- Some late leaks are clinically insignificant blind-ending tracks.
- Others manifest as severe fistulas requiring surgical intervention.