CA S E R E P O R T Open Access
Tracheoesophageal fistula after total
resection of gastric conduit for
gastro-aortic fistula due to gastric ulcer
, Masahide Fukaya
, Hironori Fujieda
, Yuzuru Kamei
, Akihiro Hirata
, Keita Itatsu
and Masato Nagino
Background: Tracheoesophageal fistula (TEF) is a rare but life-threatening complication after esophagectomy. It has
a high mortality rate and often leads to severe aspiration pneumonia. Various types of surgical repair procedures
have been reported, but the optimal management of TEF is challenging and controversial. Treatment should be
individualized to each patient.
Case presentation: A 66-year-old female underwent transthoracic esophagectomy with gastric tube reconstruction
and an intrathoracic anastomosis for esophageal cancer. Three years later, she had hematemesis and was diagnosed
with a gastro-aortic fistula due to a gastric ulcer. She underwent endovascular aortic repair urgently at another hospital.
Two days later, she underwent total resection of the gastric tube, during which time an injury to the trachea occurred;
it was repaired by patching the stump of the esophagus to the injury site. Two months later, descending aortic
replacement was performed due to infection of the stent graft. Six months after the first operation, a TEF developed.
The patient was referred to our hospital for further treatment. The fistula was ligated and divided via a cervical
approach, and a pectoralis major muscle flap was used to cover the defect. Esophageal reconstruction with the
pedunculated jejunum was performed via a subcutaneous route. The postoperative course was uneventful. The patient
was discharged after 6 months of physical and dysphagia rehabilitation.
Conclusion: A TEF located near the cervicothoracic border was successfully treated with a pectoralis major muscle
flap through a cervical approach. Total resection of a gastric conduit in the posterior mediastinum carries a risk of
tracheobronchial injury; however, if such an injury occurs, surgeons should be able to repair the injury using a suitable
flap depending on the injury site.
Keywords: Tracheoesophageal fistula, Gastric conduit ulcer, Pectoralis major muscle flap
Tracheoesophageal fistula (TEF) is a rare but life-
threatening complication after esophagectomy. It has a
high mortality rate and often leads to severe aspiration
pneumonia [1, 2]. Various types of surgical repair proce-
dures have been reported, but the optimal management
of TEF is challenging and controversial. Treatment
should be individualized to each patient.
Herein, we report a patient with a TEF after total re-
section of a gastric conduit for gastro-aortic fistula due
to a gastric ulcer, successfully repaired with a pectoralis
major muscle flap through a cervical approach.
A 66-year-old woman with esophageal cancer underwent
transthoracic esophagectomy with three-field lymph node
dissection via a muscle-sparing thoracotomy as previously
reported , with gastric conduit reconstruction and an
intrathoracic anastomosis. A high-dose proton pump in-
hibitor (PPI) was administered postoperatively due to the
patient’s history of gastric ulcers; she discontinued the
* Correspondence: firstname.lastname@example.org
Division of Surgical Oncology, Department of Surgery, Nagoya University
Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550,
Full list of author information is available at the end of the article
© The Author(s). 2017 Open Access This 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.
Sakatoku et al. Surgical Case Reports (2017) 3:90