Oesophageal adenocarcinom...

A 55-year-old male patient presented with an oesophageal distal 1/3rd poorly differentiated uT3N1 adenocarcinoma. He underwent induction chemotherapy (5FU, Cisplatin) and radiotherapy (45 Gy). Eight weeks later, a subtotal oesophagogastrectomy with radical lymphadenectomy and reconstruction using a gastric pull-up according to the Akiyama technique was performed. Final histopathology reported a poorly differentiated carcinoma with a total of twenty-three nodes examined, all free of disease. The immediate postoperative outcome was uneventful. On the 9th postoperative day, an oesophagography showed no evidence of passage disturbance. However, on the 15th postoperative day, the patient experienced severe respiratory distress and was re-admitted to the ICU. Chest CT-Scanning showed bilateral basal pneumonia. Despite negative oesophagography on the 18th postoperative day, a subsequent upper-GI endoscopy carried out 3 days later revealed an 8 mm anastomotic orifice. A further oesophagography showed pathognomonic tracheobronchial opacification with contrast swallowing. Bronchoscopy showed a necrotic defect 5 cm above the carina.