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[Diagnosis and treatment of cervical anastomotic fistula contaminating mediastinum or pleural cavity after esophagogastrostomy: a report of five cases with literature review].

BACKGROUND & OBJECTIVE
A special kind of fistula will be formed when cervical gastroesophageal anastomotic fistula occurs and its contents contaminate mediastinum or pleural cavity after esophagogastrostomy. The diagnosis and treatment are difficult to made. It is very dangerous if the treatment is incorrect. This study was to analyze the causes, preventive measures, diagnosis methods and standard, and appropriate treatments of this kind of fistula.


METHODS
Clinical data of 5 patients who suffered cervical anastomotic fistula contaminating mediastinum or pleural cavity after esophagogastrostomy, treated in our hospital, were retrospectively analyzed; the related literature was reviewed.


RESULTS
The morbidity of this kind fistula was 1.83%(4/219) in our hospital. All the 5 patients suffered fistula 1-13 days after esophagogastrostomy; bronchopleural fistula occurred in 2 patients. The main causes of this kind of anastomotic fistula were hypertensive anastomosis, low anastomotic location, incomplete suture of thorax-esophagus outlet, defection of surgical technique, and so on. The fistula could be diagnosed correctly when the patient suffered high fever, dyspnea and thoracalgia after operation, with cervical anastomotic external fistula which could not been healed when the wound was opened, X-ray-showed widened mediastinum and hydropneumothorax, and drainage, esophagoraphy and CT-confirmed anastomotic fistula. All patients were cured in a short term with sufficient drainage and irrigation, enough nutrition, appropriate use of antibiotics, and pyothorax dissection and muscle flaps transplantation for bronchopleural fistula.


CONCLUSION
Most cervical anastomotic fistulas happen 1-13 days after esophagogastrostomy with critical conditions; timely diagnosis and proper treatment including operation could shorten the disease course and greatly decrease the mortality.