A Case of Mediastinitis Caused by Anastomotic Leakage After Total Gastrectomy Treated with Thoracoscopic Debridement Under Local Anesthesia

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  • Igarashi Tomoyuki
    Department of Surgery, Division of Thoracic Surgery, Shiga University of Medical Science
  • Hayashi Kazuki
    Department of Surgery, Division of Thoracic Surgery, Shiga University of Medical Science
  • Okamoto Keigo
    Department of Surgery, Division of Thoracic Surgery, Shiga University of Medical Science
  • Kaku Ryosuke
    Department of Surgery, Division of Thoracic Surgery, Shiga University of Medical Science
  • Kataoka Yoko
    Department of Surgery, Division of Thoracic Surgery, Shiga University of Medical Science
  • Kawaguchi Yo
    Department of Thoracic Surgery, Kusatsu General Hospital
  • Ohshio Yasuhiko
    Department of Surgery, Division of Thoracic Surgery, Shiga University of Medical Science
  • Teramoto Koji
    Department of Medical Oncology, Shiga University of Medical Science
  • Hanaoka Jun
    Department of Surgery, Division of Thoracic Surgery, Shiga University of Medical Science

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Other Title
  • 局所麻酔下胸腔鏡処置で治癒した胃癌術後縫合不全による縦隔炎の1例

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<p>Background. Mediastinitis due to anastomotic leakage is one of the most serious and fatal complications of total gastrectomy. Case. A 49-year-old man presented with fever, dyspnea, and hypoxia after total gastrectomy, with a delta-shaped anastomosis on postoperative day 2. A chest radiograph revealed bilateral pneumothorax, pleural empyema, and pneumomediastinum due to anastomotic leakage at the esophagojejunal anastomosis. The patient was treated with bilateral chest drainage and antibiotics. However, his general condition did not immediately improve because the multiloculated empyema was not sufficiently drained. Therefore, we performed thoracoscopic debridement under local anesthesia on postoperative day 15, considering the patient's poor condition. After thoracoscopic debridement, the patient's condition rapidly improved and the fistula associated with the anastomotic leakage finally closed without additional treatment. Conclusion. Based on this case, thoracoscopic debridement under local anesthesia may be a suitable method for treatment of mediastinitis due to anastomotic leakage after total gastrectomy in patients with poor physical condition.</p>

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