Duodenoesophageal fistula as a rare complication following emergency total gastrectomy for caustic injury.
Papawee Chennavasin, Thitiporn Chobarporn, Chadin Tharavej et al.
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Case in brief
A patient referred for esophageal reconstruction after emergency total gastrectomy without reconstruction for caustic injury was found to have a fistula connecting the duodenal stump to the intra-abdominal esophageal stump. Investigations also showed jejunal obstruction at the feeding jejunostomy site and caustic esophageal strictures. Management combined thoracoscopic esophagectomy, feeding-jejunostomy detachment with segmental small-bowel resection, fistulectomy with resection of the duodenal stump defect, and colonic interposition. The procedures were reported as successful.
What made this case unusual
The duodenoesophageal fistula developed after emergency total gastrectomy for caustic injury, an association and surgical management that the authors state had not previously been described.
Diagnostic / clinical pearl
In a patient undergoing reconstruction after emergency gastrectomy for caustic injury, preoperative assessment may reveal a fistula between the duodenal and esophageal stumps, alongside other complications such as feeding-jejunostomy-site obstruction.