Bilirubin Crystals in Pleural Fluid

Anastomotic leakage has been responsible for 29% to 44% of the deaths after esophagogastrectomy.¹ When anastomotic leakage does occur, the associated mortality ranges from 44% to 93%.² The patient described here had an anastomotic leak develop after esophagogastrectomy; the leak was not apparent until bilirubin crystals were discovered in pleural fluid.

Report of a Case.—A 65-year-old man had dysphagia. A barium esophagram showed a lesion in the distal third of the esophagus and the results of esophagoscopy with biopsy were interpreted as showing adenocarcinoma. The patient underwent esophagogastrectomy and gastroesophageal anastomosis through a left thoracoabdominal approach, and a tube was inserted in the chest for drainage. An upper gastrointestinal fluoroscopic series on the sixth post-operative day revealed a widely patent gastroesophageal anastomosis. The next morning, severe right-sided back pain, diaphoresis, tachycardia, and progressive dyspnea developed. There was no increased drainage from the tube in the left side