We have experienced a case of penetrated ulcer of the reconstructed gastric tube to the pericardium.
A 67-year-old man was admitted to the hospital because of sudden onset of anterior chest and neck pain in February 1999. There was a previous history of undergoing a subtotal esophagectomy and a retrosternal esophagogastrostomy for carcinoma of the middle intrathoracic esophagus 4 years before admission. Chest X-ray film showed the air in the pericardial space, and computed tomography revealed the penetration of the gastric tube to the pericardium. He fell into shock condition, and percutaneous pericardial drainage was immediately performed. Conservative therapy by administration of antibiotics and H₂-blocker, and placement of a nasogastric tube was done thereafter. His general condition improved temporally. Inspite of the treatment, his respiratory condition became worse 14 days after the drainage, and he died of multiple organ failure subsequent to sepsis 18 days after the drainage. At autopsy, ulcer penetration of the gastric tube to the pericardium 15.5cm distal from the esophagogas-troanastomosis was confirmed. The size was 6×3cm. No recurrence of the esophageal cancer was observed. It is considered that the operative lavage and drainage in the pericardial space along with resection of the gastric tube and esophagocutaneostomy should be performed after improving the general condition temporally due to percutaneous drainage. We must bear in mind that ulcer of the reconstructed gastric tube can be fatal because it may cause penetration to the pericardium or large vessels. Some bibliographical comments in terms of therapeutic problems are also presented here.