A successful case of surgery using extracorporeal membrane oxygenation for reconstructed gastric tube bronchial fistula after operation of esophageal cancer

Abstract

The patient was a 72-year-old male who underwent total thoracic esophagectomy with reconstruction of the gastric tube through the posterior mediastinal route for esophageal cancer, on March 6, 1996. He received irradiation before and after the operation with a total dose of 73.1 Gy. On February 17, 1998, he suddenly suffered from dyspnea. He was diagnosed at another hospital as having an ulcer of the reconstructed gastric tube with a bronchial fistula, and was transferred to our hospital. Tracheostomy and mechanical ventilation were performed and we planned on waiting until the patient's general condition improved to tolerate an operation. The fistula, however, gradually enlarged, and the patient developed severe respiratory failure refractory to maximal conventional ventilation on the 10 th day. After cannulation with veno-venous extracorporea membrane oxygenation (ECMO), he was operated on to close the fistula using the pedicled pectoralis major muscle flap. The ECMO system was removed after 150 hours and he was able to be weaned off mechanical ventilation on the 64 th postoperative day, ECMO may be useful for patients who have to undergo surgical treatment under severe respiratory failure.