食道癌術後の右肺中葉への胃管潰瘍性穿通の1例

Gastric Conduit Ulcer Pentration into the Right Middle Lobe after Esophageal Cancer Surgery；Report of a Case

はじめに　食道癌根治術後の再建胃管における消化性潰瘍性穿通は比較的まれで報告は少ない．われわれは，食道癌術後遠隔期に潰瘍穿孔を発症し，それに起因する反復性の肺炎を合併した症例に対し，胃管の肺への穿通の外科的治療を行ったので報告する．

A 55-year-old man with esophageal cancer underwent esophagectomy along with lymph node dissection and reconstruction with gastric conduit through the sternal route. He developed a continuous cough with sputum production, 3 years postoperatively. Chest radiography revealed a right middle lung field infiltrate. Chest computed tomography revealed communication between the reconstructed esophagus and the gastric conduit （pull-up） and right middle lobe airways.

Upper gastrointestinal examination revealed ulcerative lesions involving the gastric mucosa；however, biopsy of the ulcer showed no malignancy. Conservative therapy including fasting and proton-pump inhibitor administration did not improve symptoms caused by gastropleural fistula. Thoracotomy was performed through the anterolateral intercostal space under the right-up supine position, and the partial lung resection and direct closure of the stomach with muscle flap wrapping was performed.