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Catastrophic complications of the cervical esophagogastric anastomosis

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Presentation on theme: "Catastrophic complications of the cervical esophagogastric anastomosis"— Presentation transcript:

1 Catastrophic complications of the cervical esophagogastric anastomosis
Mark D. Iannettoni, MD (by invitation), Richard I. Whyte, MD (by invitation), Mark B. Orringer, MD  The Journal of Thoracic and Cardiovascular Surgery  Volume 110, Issue 5, Pages (November 1995) DOI: /S (95) Copyright © 1995 Mosby, Inc. Terms and Conditions

2 Fig. 1 Barium esophagogram from patient with postoperative fever caused by CEGA disruption associated with gastric tip necrosis. Oblique projection demonstrates extravasation of contrast (arrow) into low posterior mediastinum alongside intrathoracic stomach, indicating major disruption. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /S (95) ) Copyright © 1995 Mosby, Inc. Terms and Conditions

3 Fig. 2 Cervical magnetic resonance imaging scan of patient 3 who had quadriplegia and neck pain from epidural abscess (arrow) that necessitated operative debridement and drainage. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /S (95) ) Copyright © 1995 Mosby, Inc. Terms and Conditions

4 Fig. 3 Chest computed tomographic scan from patient 1 demonstrating multiple pulmonary abscesses as a result of intravascular dissemination from cervical abscess formed by wall of left internal jugular vein. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /S (95) ) Copyright © 1995 Mosby, Inc. Terms and Conditions

5 Fig. 4 Contained anterior CEGA leak demonstrated on barium esophagogram 10 days after operation. Extravasated barium abutsposterior membranous trachea. This leak was asymptomatic and was notdrained. Nine days later, a tracheoesophagogastric anastomosis fistula developed and patient ultimately died of multisystem organ failure after attempted repair. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /S (95) ) Copyright © 1995 Mosby, Inc. Terms and Conditions

6 Fig. 5 Currently advocated technique of suspension stitch placement. Two anterior sutures between back of cervical esophagus and adjacent stomach limit tension on esophagogastric anastomosis and prevent needle inoculation of spine, which is inherent in posterior sutures. (Reproduced with modification with permission from Orringer MB. Transhiatal esophagectomy without thoracotomy. In: Orringer MB, Zuidema GD, eds. Shackelford's surgery of the alimentary tract. 3rd ed. Vol. 1. Philadelphia: WB Saunders, 1991.) The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /S (95) ) Copyright © 1995 Mosby, Inc. Terms and Conditions

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