Successful Conservative Management of a Contained Intrathoracic Anastomotic Leak After Ivor Lewis Esophagectomy: A Case Report

Anastomotic leakage is a potentially life-threatening complication of esophagectomy.Although endoscopic and surgical interventions are frequently required, conservative management may be appropriate in selected patients with small, contained defects and adequate drainage.We report the case of a 73-year-old man who developed an intrathoracic leak following Ivor Lewis esophagectomy for distal esophageal adenocarcinoma.Increased turbid thoracic drain output raised suspicion of leakage on postoperative day (POD) 4. Computed tomography (CT) esophagogastrography on POD 6 demonstrated contrast extravasation near the esophagogastric anastomosis, and upper endoscopy identified an approximately 3-mm defect immediately distal to the anastomosis within the proximal gastric conduit.The patient remained clinically stable, with preserved conduit viability and no diffuse mediastinal contamination.Conservative treatment consisted of continued drainage through the intraoperatively placed thoracic drain, placement of a nasojejunal feeding tube for enteral nutritional support, antimicrobial therapy, and close monitoring.Drain output ceased by POD 12, and endoscopy on POD 14 confirmed closure of the defect.Repeat CT esophagogastrography on POD 15 showed no persistent contrast extravasation.The patient was discharged on POD 23 and remained disease-free at the 12-month follow-up.This case illustrates that conservative management can achieve closure of a small, contained leak in a clinically stable patient when adequate source control is maintained, without therapeutic endoscopic intervention or surgical reintervention.