Presentation
A patient with a history of esophageal cancer two months ago underwent Ivor Lewis esophagectomy.
Patient Data
- there is noted esophagogastric anastomotic leak (failure) with the formation of a fistula to the lower lobe of the right lung. It causes a huge abscess, measuring 11 x 9 cm, with an air-fluid level
- the lumen of the remaining esophagus is dilated
- in the right pleural space, there an accumulation of fluid, about 10 HU, possible empyema
- because of the abscess and pleural effusion, there is partial passive atelectasis of the right lung
- significant calcifications of the trachea and main bronchi are present
- Red line - shows the fistula between the esophagus and lung
Case Discussion
The patient, who underwent Ivor Lewis esophagectomy, now has an esophagogastric anastomotic leak, which is a dangerous complication of the surgery.
Ivor Lewis esophagectomy is a surgery in which the esophagus is partially removed and the remaining esophagus is connected to the stomach which has been pulled into the chest cavity. As a result, the esophagogastric anastomosis is located in the chest.
In the right lung, there is an abscess because of the fistula.
There are also loculated fluid collections in the right pleural space suggesting empyema.
Surgery done the next day confirmed the diagnosis of presence of the fistula between the esophagus and the lung.
Unfortunately, the patient passed away after two days.