PMC4325191_01
Gastrointestinal fiberscopy and CT images of the gastric tube cancer. a The gastric tube cancer was located on the anterior wall of the antrum. b The gastric tube cancer was located behind the left atrium on computed tomography, and a clip was placed for radiotherapy
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Fig1
Five years later, gastrointestinal fiberscopy and endoscopic ultrasound revealed intra-submucosal gastric tube cancer, which was located on the anterior wall of the antrum (Fig. 1).
Chest X-ray and CT images upon admission. a Lobar pneumonia of the right lung, atelectasis of the right inferior lobe and right pneumothorax. b Bilateral atelectasis and pneumonia, and right pneumothorax
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Fig2
The findings of chest X-rays and CT images revealed severe pneumonia, atelectasis and pneumothorax (Fig. 2).
The bronchoscopic image showing a fistula between the base of the right inferior lobe bronchus and gastric tube. The diameter of the GBF was about 1 cm. Arrow GBF. B bronchus; G gastric tube
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Fig3
Bronchoscopy confirmed the presence of a fistula delivering digestive juice into the lung between the base of the right inferior lobe bronchus and the gastric tube (Fig. 3).
A schematic diagram of the two-stage operation. a The first procedure: the duodenum was transected, a decompression catheter was inserted into the gastric tube and esophagostomy established. b The second procedure: esophageal reconstruction was performed using a pedicled jejunum with a microvascular anastomosis through the subcutaneous route in the anterior chest wall
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Fig4
A feeding jejunostomy was also constructed for postoperative nutritional management (Fig. 4a). The anal end of the pedicled jejunum was anastomosed to the jejunum in the Roux-en-Y configuration (Fig. 4b).