Managing esophagocutaneous fistula after secondary gastric pull-up: A case report

Figure 1 Preoperative findings. A: Contrast-enhanced computed tomography with oral and intravenous contrast application showing the jugular abscess (indicated by orange arrowheads) and the fully covered self-expandable metallic stent with its proximal end in the fistula (indicated by blue arrowheads); B: Endoscopy showing fully covered self-expandable metallic stent placed in the distal stenotic esophagus with the esophagocutaneous fistula directly orally of the stent. The fistula orifice is partially covered by the stent flare; C: Endoscopy after stent extraction with the large prestenotic fistula orifice (indicated by orange arrowheads); fistula filled with pus; D: Endoscopy after endoscopic vacuum therapy with cleaned fistula (indicated by orange arrowhead). The fistula is entirely epithelized. The distal esophagus segment remains stenotic (indicated by blue arrowheads).

Figure 2 Findings during surgery. A: Free jejunal segment after reperfusion before intestinal anastomosis; orange arrowheads indicating the orifice of the gastric pull-up; blue arrowheads indicating the stenotic distal esophagus; B: Free jejunal segment after intestinal anastomosis; blue arrowheads at the mesentery of the free jejunal graft indicating the proximal esophago-jejunostomy; white arrowheads indicating distal jejuno-gastrostomy.

Figure 3 Anatomic schemes. A: Anatomy on admission; B: Reconstruction after surgery.