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Bilirubin Crystals in Pleural Fluid

Arch Surg. 1980;115(5):677. doi:10.1001/archsurg.1980.01380050097028.
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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


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