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Successful treatment of refractory complete separation of an esophagojejunal anastomosis after laparoscopic total gastrectomy: a case report

BACKGROUND: Anastomotic leakage after total gastrectomy occurs despite improvements in surgical techniques and patient management. Although many cases of dehiscence can be managed non-operatively, major leakage requires a second surgery and can potentially lead to death. Therefore, accurate and imme...

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Autores principales: Oka, Shinichi, Sakuramoto, Shinichi, Chuman, Motohiro, Aratani, Kenichi, Wakata, Mitsuo, Miyawaki, Yutaka, Gunji, Hisashi, Sato, Hiroshi, Okamoto, Koujun, Yamaguchi, Shigeki, Koyama, Isamu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5504729/
https://www.ncbi.nlm.nih.gov/pubmed/28693546
http://dx.doi.org/10.1186/s13104-017-2589-6
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author Oka, Shinichi
Sakuramoto, Shinichi
Chuman, Motohiro
Aratani, Kenichi
Wakata, Mitsuo
Miyawaki, Yutaka
Gunji, Hisashi
Sato, Hiroshi
Okamoto, Koujun
Yamaguchi, Shigeki
Koyama, Isamu
author_facet Oka, Shinichi
Sakuramoto, Shinichi
Chuman, Motohiro
Aratani, Kenichi
Wakata, Mitsuo
Miyawaki, Yutaka
Gunji, Hisashi
Sato, Hiroshi
Okamoto, Koujun
Yamaguchi, Shigeki
Koyama, Isamu
author_sort Oka, Shinichi
collection PubMed
description BACKGROUND: Anastomotic leakage after total gastrectomy occurs despite improvements in surgical techniques and patient management. Although many cases of dehiscence can be managed non-operatively, major leakage requires a second surgery and can potentially lead to death. Therefore, accurate and immediate diagnosis and treatment are essential. CASE PRESENTATION: In this report, we describe a 66-year-old Japanese man who was diagnosed with a complete separation of an esophagojejunal anastomosis after laparoscopic total gastrectomy with oral contrast radiography using Gastrografin(®). The severe complication was successfully treated by re-anastomosis after two emergency drainage surgeries. After the second surgery, the esophageal end formed a fistula with the jejunum, but balloon dilation failed to open the fistula. Therefore, oral ingestion and conservative treatment were considered unsuitable, and we performed esophagojejunal re-anastomosis 7 months after the first surgery. At a follow-up examination 2 years after re-anastomosis, the patient weighed 47 kg, and his ingestion had recovered to 80% of that before surgery. CONCLUSIONS: Complete separation of an esophagojejunal anastomosis is a rare but severe complication of total gastrectomy. Therefore, we consider that once separation is diagnosed, aggressive and urgent re-operation and effective drainage are useful. Moreover, it is necessary to take great care to minimize the operative morbidity associated with esophagojejunal anastomosis.
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spelling pubmed-55047292017-07-12 Successful treatment of refractory complete separation of an esophagojejunal anastomosis after laparoscopic total gastrectomy: a case report Oka, Shinichi Sakuramoto, Shinichi Chuman, Motohiro Aratani, Kenichi Wakata, Mitsuo Miyawaki, Yutaka Gunji, Hisashi Sato, Hiroshi Okamoto, Koujun Yamaguchi, Shigeki Koyama, Isamu BMC Res Notes Case Report BACKGROUND: Anastomotic leakage after total gastrectomy occurs despite improvements in surgical techniques and patient management. Although many cases of dehiscence can be managed non-operatively, major leakage requires a second surgery and can potentially lead to death. Therefore, accurate and immediate diagnosis and treatment are essential. CASE PRESENTATION: In this report, we describe a 66-year-old Japanese man who was diagnosed with a complete separation of an esophagojejunal anastomosis after laparoscopic total gastrectomy with oral contrast radiography using Gastrografin(®). The severe complication was successfully treated by re-anastomosis after two emergency drainage surgeries. After the second surgery, the esophageal end formed a fistula with the jejunum, but balloon dilation failed to open the fistula. Therefore, oral ingestion and conservative treatment were considered unsuitable, and we performed esophagojejunal re-anastomosis 7 months after the first surgery. At a follow-up examination 2 years after re-anastomosis, the patient weighed 47 kg, and his ingestion had recovered to 80% of that before surgery. CONCLUSIONS: Complete separation of an esophagojejunal anastomosis is a rare but severe complication of total gastrectomy. Therefore, we consider that once separation is diagnosed, aggressive and urgent re-operation and effective drainage are useful. Moreover, it is necessary to take great care to minimize the operative morbidity associated with esophagojejunal anastomosis. BioMed Central 2017-07-11 /pmc/articles/PMC5504729/ /pubmed/28693546 http://dx.doi.org/10.1186/s13104-017-2589-6 Text en © The Author(s) 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Case Report
Oka, Shinichi
Sakuramoto, Shinichi
Chuman, Motohiro
Aratani, Kenichi
Wakata, Mitsuo
Miyawaki, Yutaka
Gunji, Hisashi
Sato, Hiroshi
Okamoto, Koujun
Yamaguchi, Shigeki
Koyama, Isamu
Successful treatment of refractory complete separation of an esophagojejunal anastomosis after laparoscopic total gastrectomy: a case report
title Successful treatment of refractory complete separation of an esophagojejunal anastomosis after laparoscopic total gastrectomy: a case report
title_full Successful treatment of refractory complete separation of an esophagojejunal anastomosis after laparoscopic total gastrectomy: a case report
title_fullStr Successful treatment of refractory complete separation of an esophagojejunal anastomosis after laparoscopic total gastrectomy: a case report
title_full_unstemmed Successful treatment of refractory complete separation of an esophagojejunal anastomosis after laparoscopic total gastrectomy: a case report
title_short Successful treatment of refractory complete separation of an esophagojejunal anastomosis after laparoscopic total gastrectomy: a case report
title_sort successful treatment of refractory complete separation of an esophagojejunal anastomosis after laparoscopic total gastrectomy: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5504729/
https://www.ncbi.nlm.nih.gov/pubmed/28693546
http://dx.doi.org/10.1186/s13104-017-2589-6
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