DELAYED LEAKS AND FISTULAS AFTER ESOPHAGOGASTRECTOMY - RADIOLOGIC EVALUATION

OBJECTIVE. Although breakdown of the esophagogastric anastomosis often occurs as a complication of esophagogastrectomy during the early postoperative period, it is not well recognized that anastomotic leaks and fistulas may occur during the late postoperative period (more than 1 month after surgery). The purpose of our study was to determine the radiologic appearance and clinical significance of these late leaks and fistulas. MATERIALS AND METHODS. A review of radiology records at our hospital from 1985 to 1991 revealed 37 patients who had upper gastrointestinal contrast studies an average of 13.3 months after esophagogastrectomy. RESULTS. Six patients (16%) had anastomotic leaks or fistulas that occurred during the late postoperative period. Four patients were asymptomatic; three had contrast studies that showed thin, blind-ending tracks extending from the anastomosis into the mediastinum, and the fourth had an esophagogastric fistula. One of the blind-ending tracks later progressed to a gastropleural fistula that was treated with antibiotics and drainage. One symptomatic patient had a gastropleural fistula, and the other had a gastrobronchial fistula. Both fistulas were surgically repaired. None of the leaks or fistulas was associated with recurrent tumor. CONCLUSION. Anastomotic leaks or fistulas may be detected on contrast studies obtained more than 1 month after esophagogastrectomy. Some leaks appear as blind-ending tracks that have no clinical significance, but others may be manifested by life-threatening gastropleural or gastrobronchial fistulas that necessitate surgical intervention.