PMC7341059_01
Preoperative findings of esophagogastric junction cancer.. a: Long segment Barrett's esophagus (LSBE) was noted on endoscopy.. b: A 1/3 circumference ill-demarcated depressed lesion with redness in Barrett's esophagus was noted (arrowheads).. c: EUS finding (20 MHz). The tumor was located in the fourth layer and in contact with the fifth layer.. d: The tumor could not be identified by CT, and there was no swelling of the lymph nodes.
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Barrett's esophagus (Fig. 1a, b). Biopsy revealed adenocarcinoma of the esophagus, consistent with Barrett's adenocarcinoma. Endoscopic ultrasound (EUS) findings revealed that the lesion was located in the fourth layer and in contact with the fifth layer (Fig. 1c). The lesion could not be identified by computed tomography (CT), and there was no swelling lymph node or distant metastasis (Fig. 1d).
Pre- and postoperative imaging findings.. a: CT showed pneumomediastinum around the anastomosis, bilateral pleural effusion and atelectasis.. b: There was no anastomotic leakage on fluoroscopic examination. The arrow indicates the T-drain.. c: The T-shaped portion of the T-drain was cut off by peroral endoscopic treatment.
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CT examination. CT revealed pneumomediastinum around the anastomosis, bilateral pleural effusion and atelectasis, while the contrast effect of the gastric conduit was preserved (Fig. 2a). T-drain were removed by postoperative day 36. There was no anastomotic leakage on fluoroscopic examination (Fig. 2b), and oral intake was started on postoperative day 41. After fistula formation, the T-shaped portion of the T-drain was cut off by peroral endoscopic treatment (Fig. 2c) and phased out slowly.
Findings on reoperation.. a: The perforation was found on the back side of the esophagogastric anastomosis (arrowheads).. b: The T-drain was inserted through the perforation.. c: The T-drain was fixed with an elastic suture.. d: Portable low-pressure suction drains were placed and fixed in the front and back of the anastomosis.
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The perforation, which was approximately 8 mm in length, was found at the end of the esophagogastric anastomosis (Fig. 3a). A T-drain was inserted through the perforation and fixed with an elastic suture because the tissue around the perforation seemed to be too weak to perform primary suture (Fig. 3b, c). Tokyo, Japan) were placed and fixed in the front and back of the anastomosis (Fig. 3d).