PMC6360347_01
(A) Gastroscopy showing a fistula in the thoracic anastomosis; (B) Barium oesophagogram showing an outflow of the contrast agent from the thoracodorsal sinus tract; (C) Gastroscopy showing a gastroesophageal anastomotic fistula.
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On the 11th postoperative day (subsequent days refer to the first operation), she began to vomit foul-smelling gastric juice; gastroscopy found a thoracic anastomosis fistula, and the size of orificium fistulae accounted for 1/3-1/2 of the anastomotic circumference (Fig. 1A). On the 30th postoperative day, barium oesophagogram revealed that the contrast agent outflowed from the thoracodorsal sinus tract (Fig. 1B), and gastroscopy confirmed a 10-cm long longitudinal gastric fissure (approximately 20-30 cm away from the patient's incisor), which appeared on the greater curvature side (Fig. 1C).
(D) and (E) CT showing the occurrence of tracheostenosis; (F) X-ray showing chest collapse after thoracoplasty and a normal tracheal morphology.
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On the 80th postoperative day, CT and fibreoptic bronchoscopy found a bound tracheostenosis located in the midtrachea (Fig. 2D, E). When thoracic cavity infection was limited and respiratory dyspnoea was relieved, a third surgery was performed, on the 90th postoperative day, to correct the tracheostenosis, repair the thoracic gastric fissure by filling it with a pedicled muscle flap, partly resect ribs 4-7, and close the thoracodorsal orificium fistula and vomicae (Fig. 2F).