Use of Esophageal Stents After Anastomotic Leakage in Surgery for Gastric Adenocarcinoma Case Report and Review of the Literature
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2018, Vol 6, Issue 4
Abstract
Introduction: Radical gastrectomy is the treatment of choice for the treatment of gastric cancer located in the upper third of stomach or in case of diffuse histology or cells in a signet ring. The worst complication after a radical gastrectomy is the leakage of the esophago-jejunal anastomosis, since it considerably increases the morbidity and mortality of the patient. Case Report:Wedescribe our experience after performing a radical gastrectomy for gastric adenocarcinoma in a patient who developed a leakage of the esophago-jejunal anastomosis in the postoperative period. Although he was reoperated, performing reinforcement of the anastomosis and making a feeding jejunostomy, the dehiscence progressed in the following days until it became almost complete. Then, we proceeded to place a digestive endoprosthesis through gastroscopy with good results, allowing the entire defect to heal and being able to be removed without incidents after 8 weeks. Discussion: There are several alternatives after a leakage of the esophago-jejunal anastomosis. Surgical options include reinforcement of the defect, resection and new anastomosis and esophageal exclusion. However, these options increase the morbidity and mortality of the patient and may require a second intervention in a second time to re-establish the transit. In recent years, the use of digestive stents placed by endoscopy in patients with anastomotic leakage after gastrectomy has proved to be a valid treatment option in selected patients. Gastric cancer continues to be one of the malignant neoplasms of the gastrointestinal tract that causes the greatest number of cancer deaths in our days [1]. In patients with gastric cancer in the upper third or whose biopsy has confirmed the presence of a diffuse type adenocarcinoma or signet ring cells, a radical gastrectomy is the treatment of choice [2,3]. However, the dehiscence of esophago-jejunal anastomosis after gastrectomy for cancer is between 3-20% with a mortality of up to 60%, greater after surgical reoperation than by endoscopic management [4,5]. The leakage of this anastomosis supposes an increase of the morbidity, since it is a delay in the beginning of the enteral nutrition increasing the hospital stay. In addition, its management is a challenge for the surgeon, since the surgical options range from reinforcing or redoing the anastomosis to performing an esophageal diversion. In recent years, the use of stents placed by endoscopy have been shown to reduce morbidity and mortality in selected patients, becoming a treatment option in the management of esophageal fistula. Next, we describe the case of a patient who was operated for gastric adenocarcinoma, performing a radical gastrectomy, which presented as acomplication an esophago-jejunal fistula of practically all the circumference resolved by placement of an esophageal stent.
Authors and Affiliations
Mendoza Moreno, Díez Gago, Mínguez García, Enjuto Martínez, Tallón Iglesias, Solana Maoño, Argüello-de Andrés JM
Keywords
Related Articles
- EP ID EP592376
- DOI 10.26717/BJSTR.2018.06.001391
- Views 169
- Downloads 0
Paget’s Disease of the Nipple Presenting as Non-Healing Ulcerative Lesion of Nipple: A Case Report and Review of Literature
Paget’s disease of the breast is a rare condition of the nipple areola complex and is often associated with an underlying in situ or invasive carcinoma. It continues to pose as a diagnostic dilemma. Pagets disease of the...
Studies on the Physicochemical Parameters of the Fixed Oils of Cinnamonum Zeylanicum
The present work was carried out to analyze the physicochemical parameters of fixed oils of Cinnamonum zeylanicum. The oil was extracted from freshly bark of Cinnamonum zeylanicum with petroleum ether using Soxhlet appar...
Actuator for Nano biomedical Research
In this work, we obtain the parameters of the actuator for nano biomedical research. We have mathematical model of the actuator with the piezoelectric or magneto strictive effect.Actuator for nano biomedical research is...
Ashman Phenomenon: Looked but Invisible
The Ashman phenomenon is aberrant ventricular conduction that usually seen in atrial fibrillation. It does not require a specific treatment; it is usually treated according to the underlying cause. Differential diagnosis...
Function of Air-Abrasion Device During Open Flap Surgery in Resective and Regenerative Periodontal Therapy: Case Reports
Background: One of the basic pillars of periodontal surgery is open flap surgery, which preserves the regeneration skill of the periodontium. The aim of this case report is to present a novel approach to the effects of a...