Purulent spondylitis related to anastomotic fistula after esophageal cancer surgery.

Abstract

A 73-year-old man underwent neoadjuvant chemotherapy followed by transhiatal esophagectomy with gastric tube reconstruction for advanced esophageal cancer with palliative intent. Cervical esophagogastrostomy with circular-stapled end-to-side anastomosis was performed; however, anastomotic fistula developed. Fever, severe pain in the nape of the neck and numbness of the left hand were noted after drainage by wide opening of cervicotomy and the administration of empiric antibiotics. Magnetic resonance imaging revealed high signal intensity between the inferior C5 vertebral body and the intervertebral disc on T2-weighted images, and some areas were contrast-enhanced, suggesting purulent spondylodiscitis. Because methicillin-resistant Staphylococcus aureus was detected by bacterial culture from the drained pus, sensitive antibiotics were given, and those symptoms improved rapidly without sequelae.

• Authors: Tomoyuki Kakuta, Shin-ichi Kosugi, Tatsuo Kanda, Katsuyoshi Hatakeyama
• Journal: Interactive cardiovascular and thoracic surgery (Interact Cardiovasc Thorac Surg) Vol. 11 Issue 2 Pg. 204-6 (Aug 2010) ISSN: 1569-9285 [Electronic] England
• PMID: 20442207 (Publication Type: Case Reports, Journal Article)

Chemical References

• Anti-Bacterial Agents

Topics

• Aged
• Anastomosis, Surgical
• Anti-Bacterial Agents (therapeutic use)
• Drainage
• Esophageal Fistula (microbiology, therapy)
• Esophageal Neoplasms (surgery)
• Esophagectomy (adverse effects)
• Fatal Outcome
• Fever (microbiology)
• Humans
• Hypesthesia (microbiology)
• Magnetic Resonance Imaging
• Male
• Methicillin-Resistant Staphylococcus aureus (isolation & purification)
• Neck Pain (microbiology)
• Spondylitis (microbiology, therapy)
• Surgical Wound Infection (microbiology, therapy)
• Treatment Outcome