Gastric cancer
- 60-year-old male
- Total gastrectomy and distal esophagectomy with abdominal esophago-jejunal anastomosis
- Anastomotic leakage treated with VAC-Sponge
Surgery
- Total gastrectomy and distal esophagectomy, with en-bloc resection of partial left liver lobe, pancreatic tail, spleen and left transverse colon, including splenic flexure;
- Reconstruction with Roux-Y esophago-jejunostomy. Terminal transversostomy;
6days post-surgery
- Malaise, pain upper abdomen, N-V-, no dyspnoea
- Atrial flutter, RR 95/66, T 36.0 C
- Lab: Leukocytes 23.7, CRP 216
CT-scan with oral contrast: bilateral leakage of contrast towards pleural cavity.
After CT-scan
- Placement of thoracic drain right
- Mediastinitis protocol
- Endoscopy
Anastomotic leakage with 50% circumference of dehiscence of esophago-jejunal anastomosis at 33cm with 10cm cavity depth.
Treatment with VAC-Sponge was initiated
- As colon interposition is not an option;
- Initially, 1 VAC-Sponge was placed intraluminally;
- After 5 days, endoscopy showed a dehiscence of 75% of the circumference.
Endoscopy after 5 days with intraluminal VAC-Sponge: anastomotic dehiscence of 75% of the circumference
Continuation of treatment with VAC-Sponge
- 2 VAC-Sponges were placed intracavitary;
- Once the cavity was smaller, 1 VAC-Sponge was placed intracavitary, until the cavity was small enough to switch to intraluminal treatment;
Treatment characteristics
- Treatment duration: 42 days
- VAC-Sponge cycles: 12
- Days between sponge exchanges: approx. 3-4 for intracavitary sponges and 7 for intraluminal sponges
- Vacuum settings: -50mmHg for intracavitary sponges and -75mmHg for intraluminal sponges
Endoscopic images after respectively 4, 8 and 12 cycles of VAC-Sponge treatment