Diagnosis and management of concealed thoracic cavity fistula in postoperative patients with esophageal or cardia carcinoma / 肿瘤研究与临床

ABSTRACT

Objective To investigate diagnosis and treatment of concealed thoracic cavity fistula in the postoperative patients of esophagus or cardia carcinoma.Methods The clinical data of 40 patients were analyzed who presented with unexplained sepsis (elevated white blood cell count and temperature＞38 ℃) after esophagectomy and intrathoracic anastomosis from January 2010 to September 2013.All patients underwent oral meglumine diatrizoate esophageal imaging and computerized tomography scan of the chest.None of the patients had any sign of contrast leak in the early in these diagnostic examinations,but their chest CT scan all showed peri-anastomotic or the gastric remnant diffuse bubble and bit encapsulated effusion.Twenty patients were treated as concealed intrathoracic anastomotic or the gastric remnant leak including fasting,broad spectrum antibiotic treatment,kept the gastrointestinal decompression and enteral nutrition via naso-intestinal feeding tube.The other twenty patients were not treated only received broad spectrum antibiotic treatment.Results Two of the 20 patients in group of who were treated as concealed intrathoracic leak finally developed intrathoracic leak proved by oral meglumine diatrizoate esophageal imaging and CT scan (10 ％,2/20).Among the twenty patients who were not treated as intrathoracic leak,seventeen patients developed intrathoracic leak (85 ％,7/20),six patients died of multiple organ dysfunction syndrome.Conclusions Perianastomotic or the gastric remnant diffuse bubble and irregular encapsulated effusion in oral meglumine diatrizoate esophageal imaging and CT scan of the chest should be considered as specific signs of concealed intrathoracic anastomotic or the gastric remnant leak after esophagectomy and intrathoracic anastomosis.Patients with such signs should be treated as intrathoracic leak.