Gastric Conduit Perforation: A Late Fatal Complication after Esophagectomy

With an increasing number of long-term survivors of carcinoma esophagus, it is important to be vigilant about postoperative complications related to gastric tubes. Perforation of the gastric conduit has been rarely seen, with very few case reports in the literature. We report a rare case of perforation of the gastric tube conduit in a patient who had previously undergone esophagectomy for squamous cell carcinoma of esophagus five years ago. The patient presented with diffuse peritonitis in an emergency. On exploration, a large perforation was present on the anterior wall of the gastric conduit. This was closed with primary suture repair. Histopathology revealed nonspecific inflammatory changes. Unfortunately, the patient succumbed to severe sepsis and multiorgan dysfunction despite early surgical intervention and critical care management. Conduit perforation can be a major source of morbidity and mortality. Although gastric conduit is predisposed to ulcer formation due to multiple reasons, conduit perforation may occur only in rare cases. We recommend that surveillance endoscopy for conduit ulcer should be performed in long-term survivors after esophagectomy. Patients with conduit ulcers would benefit from long-term acid suppression with proton-pump inhibitors.