Mid-esophageal carcinoma
- 73-year-old male
- McKeown esophagectomy with cervical esophago-gastric anastomosis
- Anastomotic leakage treated with VAC-Sponge
11days post-surgery
- Fever, coughing
- Lab: Leucocytes 11.9; CRP 262
- CT-scan with oral contrast was performed
Leakage of proximal anastomosis with large mediastinal collection.
After CT-scan
- Nil by mouth
- Mediastinitis protocol
- Endoscopy
Leakage of gastro-esophageal anastomosis with 50% dehiscence of the circumference at 23cm. Deep mediastinal cavity with debris and blood cloths. Vital gastric conduit.
Treatment with VAC-Sponge was initiated
- Initially, 1 VAC-Sponge was placed intracavitary;
- Once the cavity was smaller, treatment was switched to intraluminal.
Treatment characteristics
- Treatment duration: 35 days
- VAC-Sponge cycles: 9
- 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 2, 7 and 9 VAC-Sponge cycles.