P1.039. Endoscopic Drainage for Gastric Tube–Pericardial Fistula After Esophagectomy: A Rare Case

Abstract

Abstract Topic Benign Disease: Iatrogenic Esophageal Disease, Perforation and Postsurgical Complications Case Submission: A 60-year-old man was brought to the emergency department in shock. He had undergone undergoing subtotal esophagectomy with mediastinoscopic assistance for esophageal cancer two years earlier. Laboratory tests showed WBC 22,700/μL, CRP 22.5 mg/dL, and hemoglobin 6.1 g/dL. Computed tomography revealed cardiomegaly, right pleural effusion, and free air within the pericardial cavity. Upper gastrointestinal endoscopy demonstrated a 5-mm perforation on the anterior aspect of the left wall of the lower gastric tube. Based on these findings, mediastinitis and purulent pericarditis secondary to gastric tube ulcer perforation were diagnosed. Laparoscopic surgery was performed with the aim of draining the mediastinal abscess through the esophageal hiatus and closing the perforation. Although careful dissection was attempted while preserving the right gastroepiploic vessels, severe adhesions prevented entry into the mediastinum, and the perforated ulcer could not be reached. Drinage of the contaminated area and creation of a jejunostomy were performed instead. On the following day, the patient remained febrile with persistent inflammation. Contrast study through the perforation site revealed direct opacification of the pericardial cavity. Under endoscopic guidance, a guidewire was advanced from the gastric perforation into the pericardial space, and an 8-Fr drainage tube was inserted. Following endoscopic drainage, the inflammatory response improved markedly. By the third week of treatment, endoscopy confirmed healing of the ulcer, allowing removal of the drainage tube and initiation of oral intake. The patient was discharged on postoperative day 28. We report a rare case of benign gastric tube–pericardial fistula after esophagectomy that was successfully treated with endoscopic drainage.