Fistula to the native esophagus after pharyngogastrostomy for malignant disease: A rare phenomenon in esophageal surgery

• Published in: Thoracic cancer 2013, Vol.4 (1), p.71-74
• Main Authors: Hernández Hernández, Juan Ramón, Navarro Barlés, Gonzalo, López-Tomassetti Fernández, Eudaldo M, Vega Benítez, Victor, Núñez Jorge, Valentín
• Format: Report
• Language: English
• ISSN: 1759-7714
• DOI: 10.1111/j.1759-7714.2012.00112.x

This article features the case study of a 32-year-old female patient who had undergone surgery to remove a cervical spine tumor and who later developed cervical esophagus necrosis secondary to the erosion caused by an osteosynthesis 13 years after her prosthetic cervical surgery. Barium swallow did not show anything abnormal, but after an emergency spiral computerized axial tomography (CAT) scan, a paravertebral abscess was found, along with displacement of the fixation plate and the disappearance of the esophageal silhouette on coronal sections. The patient underwent surgery to drain the abscess, extract the osteosynthesis materials and the stabilization plates, and to perform a temporary esophageal exclusion. Two months after this surgery the esophagus was reconstructed by performing a retrosternal pharyngogastrostomy without resection of the remaining cervicothoracic esophagus due to severe fibrosis and the absence of local recurrence. During the immediate post operatory period the patient developed a cervical fistula and after a month of conservative treatment, severe dysphagia was observed. Imaging tests showed a spontaneous fistula from the pharynx to the native esophagus, which prompted extraordinary treatment. Therefore, a jejunal loop was taken to the esophagus in the hiatus with a Roux-en-Y anastomosis to resolve this condition.