Distal esophageal carcinoma
- 72-year-old male
- Ivor Lewis esophagectomy with intrathoracic esophago-gastric anastomosis
- Anastomotic leakage treated with VAC-Sponge
10days post-surgery
- Confused during night, agitated, dyspnoea
- Thoracic subcutaneous emfysema, atrial fibrillation de novo, RR 136/81, T 37.7 C
- Lab: Leukocytes 13.8; CRP 219
- CT-scan with oral contrast is performed
- After CT-scan, a pigtail drain is placed into the prevertebral/midthoracic collection.
Enlarged mediastinal- and right pleural collection originating from anastomotic site with adjacent air configurations.
11days post-surgery
- Lab: L 13.4 (13.8), CRP 240 (219)
- An endoscopy was performed
Extensive amount of pus. Anastomotic leakage with a 50% dehiscence of the circumference at 28cm. Deep contaminated mediastinal cavity, identification of pigtail. Vital gastric conduit.
Treatment with VAC-Sponge was initiated
As the mediastinal cavity collapsed adequately with VAC-Sponges, it was decided to remove the pigtail drain and treat the defect and cavity with only VAC-Sponges.
- Initially, 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: 71 days
- VAC-Sponge cycles: 16
- 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
Respectively: 2 VAC-Sponges intracavitary, cavity after 2nd and 4th sponge exchange.
Respectively: cavity after 6 sponge exchanges, esophageal lumen after 12 and after 16 sponge exchanges.