Diagnosis and Management of Concealed Intrathoracic Anastomotic Leak of Esophagus_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIU Kui , YANG Xiuzhi , WANG Mingzhao , WANG Dong , WANG Zizong , SHEN Yi , WEI Yucheng.

Department of Thoracic Surgery, Affiliated Hospital of Medical College, Qingdao University, Qingdao 266003, Shandong, P. R. China;;
Email：yjdfff125@msn. cn;

Corresponding author：

Keywords：

Esophageal carcinoma; 　Intrathoracic anastomosis; 　Concealed anastomotic leak; 　Diagnosis; 　Treatment

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Abstract：　Objective　To investigate diagnosis and treatment of concealed intrathoracic anastomotic leak of the esophagus.　Methods　We retrospectively analyzed the clinical data of 32 patients who presented with unexplained sepsis （temperature＞38 ℃ and elevated white blood cell count） after esophagectomy and intrathoracic anastomosis for esophageal　carcinoma or gastric cardia carcinoma in Affiliated Hospital, Medical College of Qingdao University from January 2006 to December 2010. All the patients underwent oral water-soluble contrast esophagogram and oral water-soluble contrast computerized tomography of the chest. None of the patients had any sign of contrast leak in these diagnostic examinations, but their chest computerized tomography all showed peri-anastomotic bubble and encapsulated effusion. Fifteen patients were treated as concealed intrathoracic anastomotic leak of the esophagus, including fasting, broad spectrum antibiotic treatment, prolonged gastrointestinal decompression and enteral nutrition via naso-intestinal feeding tube. The other 17 patients were not treated as anastomotic leak of the esophagus and only received broad spectrum antibiotic treatment. Results None of the 15 patients who were treated as concealed intrathoracic anastomotic leak finally developed anastomotic leak proved by oral water-soluble contrast esophagogram and computerized tomography of the chest （0%, 0/15）. Among the 17 patients　who were not treated as anastomotic leak, fourteen patients developed anastomotic leak later （82.4%, 14/17）, 2 patients died of aorto-esophageal fistula and 3 patients died of multiple organ dysfunction syndrome.　Conclusion　Peri-anastomotic bubble and irregular encapsulated effusion in oral water-soluble contrast esophagogram and computerized tomography of the chest should be considered as specific signs of concealed intrathoracic anastomotic leak of esophagus after esophagectomy and intrathoracic anastomosis. Patients with such signs should be treated as anastomotic leak.

Citation： LIU Kui,YANG Xiuzhi,WANG Mingzhao,WANG Dong,WANG Zizong,SHEN Yi,WEI Yucheng.. Diagnosis and Management of Concealed Intrathoracic Anastomotic Leak of Esophagus. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2012, 19(4): 399-401. doi: Copy

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6.	Urschel JD. Esophagogastrostomy anastomotic leaks complicating esophagectomy：a review. Am J Surg， 1995， 169 （6）：634-640.
7.	Behzadi A， Nichols FC， Cassivi SD， et al. Esophagogastrectomy：the influence of stapled versus hand-sewn anastomosis on outcome. J Gastrointest Surg， 2005， 9 （8）：1031-1042.
8.	Martin LW， Swisher SG， Hofstetter W， et al. Intrathoracic leaks following esophagectomy are no longer associated with increased mortality. Ann Surg， 2005， 242 （3）：392-399.
9.	邱能庸，朱宪明，高旭东，等. 35例食管破裂与穿孔的诊治. 中国胸心血管外科临床杂志， 2007， 14 （4）：265．.
10.	Briel JW， Tamhankar AP， Hagen JA， et al. Prevalence and risk factors for ischemia， leak， and stricture of esophageal anastomosis：gastric pull-up versus colon interposition. J Am Coll Surg， 2004， 198 （4）：536-542.
11.	Strauss C， Mal F， Perniceni T， et al. Computed tomography versus　water-soluble contrast swallow in the detection of intrathoracic anastomotic leak complicating esophagogastrectomy （Ivor Lewis）：a prospective study in 97 patients. Ann Surg， 2010， 251 （4）：647-651.
12.	Maher MM， Lucey BC， Boland G， et al. The role of interventional radiology in the treatment of mediastinal collections caused by　esophageal anastomotic leaks. AJR Am J Roentgenol， 2002， 178 （3）：649-653.
13.	刘勇恩，寇瑛琍. 食管癌术后肺部并发症发生的原因及防治进展. 中国胸心血管外科临床杂志， 2008， 15 （2）：138-142．.

1. 　Orringer MB， Marshall B， Iannettoni MD. Transhiatal esophage　ctomy：clinical experience and refinements. Ann Surg， 1999， 230 （3）：392-400.
2. 　Müller JM， Erasmi H， Stelzner M， et al. Surgical therapy of oesop-hageal carcinoma. Br J Surg， 1990， 77 （8）：845-857.
3. 　Ercan S， Rice TW， Murthy SC， et al. Does esophagogastric anastomotic technique influence the outcome of patients with esophageal Cancer ? J Thorac Cardiovasc Surg， 2005， 129 （3）：623-631.
4. 　Swanson SJ， Batirel HF， Bueno R， et al. Transthoracic esophagectomy with radical mediastinal and abdominal lymph node dissection and cervical esophagogastrostomy for esophageal carcinoma. Ann Thorac Surg， 2001， 72 （6）：1918-1924.
5. 　Briel JW， Tamhankar AP， Hagen JA， et al. Prevalence and risk factors for ischemia， leak， and stricture of esophageal anastomosis：gastric pull-up versus colon interposition. J Am Coll Surg， 2004，198 （4）：536-542.
6. 　Urschel JD. Esophagogastrostomy anastomotic leaks complicating esophagectomy：a review. Am J Surg， 1995， 169 （6）：634-640.
7. 　Behzadi A， Nichols FC， Cassivi SD， et al. Esophagogastrectomy：the influence of stapled versus hand-sewn anastomosis on outcome. J Gastrointest Surg， 2005， 9 （8）：1031-1042.
8. 　Martin LW， Swisher SG， Hofstetter W， et al. Intrathoracic leaks following esophagectomy are no longer associated with increased mortality. Ann Surg， 2005， 242 （3）：392-399.
9. 　邱能庸，朱宪明，高旭东，等. 35例食管破裂与穿孔的诊治. 中国胸心血管外科临床杂志， 2007， 14 （4）：265．.
10. 　Briel JW， Tamhankar AP， Hagen JA， et al. Prevalence and risk factors for ischemia， leak， and stricture of esophageal anastomosis：gastric pull-up versus colon interposition. J Am Coll Surg， 2004， 198 （4）：536-542.
11. 　Strauss C， Mal F， Perniceni T， et al. Computed tomography versus　water-soluble contrast swallow in the detection of intrathoracic anastomotic leak complicating esophagogastrectomy （Ivor Lewis）：a prospective study in 97 patients. Ann Surg， 2010， 251 （4）：647-651.
12. 　Maher MM， Lucey BC， Boland G， et al. The role of interventional radiology in the treatment of mediastinal collections caused by　esophageal anastomotic leaks. AJR Am J Roentgenol， 2002， 178 （3）：649-653.
13. 　刘勇恩，寇瑛琍. 食管癌术后肺部并发症发生的原因及防治进展. 中国胸心血管外科临床杂志， 2008， 15 （2）：138-142．.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Diagnosis and Management of Concealed Intrathoracic Anastomotic Leak of Esophagus

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