PMC10280607_01
Preoperative findings. (A) Preoperative 12-lead electrocardiogram (ECG) showing ST elevation at I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5, and V6. This is a finding of pericarditis. (B) No obvious abnormal findings on chest and abdominal radiographs, but impression of slightly enlarged cardiac shadow on the chest radiograph. (C) Contrast computed tomograms (CTs) in axial view. Postesophageal cancer surgery: a gastric tube is placed through the retrosternal route. Free air and abscesses are observed around the gastric tube and pericardium. (D) Contrast CT in sagittal view. Air in the gastric tube enters the pericardium.
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An electrocardiogram and chest and abdominal radiographs are shown in Figure 1A,B, respectively. Contrast-enhanced computed tomography (CT) showed free air around the gastric tube of the retrosternal route, fluid collection in the pericardial sac that appeared like an abscess, and continuity between the gastric tube and pericardium (Figure 1C,D).
Intraoperative photographs. (A) Gastric tube after median sternotomy. A midline sternal incision is connected to the neck and abdomen. (B) The dorsal gastric tract is perforated in the pericardium. The myocardium is discolored to slightly white. (C) Reconstruction with right ileocolon after gastric tube removal through the retrosternal route. (D) Illustration of right colon reconstruction. Three anastomoses are present in the reconstruction: between the cervical esophagus and ileum of the elevated ileocolon, between the colon of the elevated ileocolon and upper jejunum, and between the remaining ileum and transverse colon.
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First, the cervical esophagus was secured from the cervical incision, then median sternotomy and laparotomy were performed (Figure 2A), and finally the perforated gastric tube was removed. A large perforation was observed in the dorsal side of the gastric tube and pericardium (Figure 2B). The myocardium was discolored, and a large amount of contaminated fluid was observed in the pericardium (Figure 2B). Although the residual cervical esophagus was quite short, anastomosis was performed with the elevated ileocolon (Figure 2C,D).