Stent misplacement across an esophagogastric anastomotic fistula post-ivor Lewis esophagectomy: A case report

Ivor Lewis esophagectomy is surgically demanding technique performed by well experienced surgeons with the main goal is complete resection of cancer and lymph nodes with two important benefits for the patient postoperatively including less respiratory adverse events and less postoperative pain. We describe a case of a 72-year-old male patient with a history of esophageal adenocarcinoma. Patient underwent Ivor Lewis esophagectomy for resection of the cancer that was complicated by esophago-gastric anastomotic fistula and pleural abscess formation requiring endoscopic stent and thoracic drain placement. However, upper gastrointestinal series (UGI) showed widening of the fistula suggesting distal stent perforation into the mediastinum confirmed by gastroscopy and requiring further surgical intervention. Patient underwent liberation of the previous esophago-gastric anastomosis and the esophagus up to the level of the cervical esophagus, and removal of the in-situ stent and transection, followed by colonic interposition 3 weeks after the initial diagnosis of the esophagogastric anastomotic fistula. Patient recovered after a prolonged hospital stay.