'Noninvasive' Treatment of Esophagogastric Anastomotic Leakage

To the Editor.—Leakage after esophagogastric or esophagojejunal anastomosis is followed by a high mortality and morbidity. The usual treatment for this complication is surgical drainage of the leak by laparotomy, thoracotomy, or reanastomosis. Herein, we describe a case in which an esophagogastric anastomotic leak into the mediastinum was successfully treated by an unorthodox means, ie, drainage of the leak via a nasoesophageal tube placed through the anastomotic defect into the mediastinum.

Report of a Case.—A 69-year-old man with carcinoma of the distal one third of the esophagus underwent a distal esophagectomy and proximal gastrectomy. An end-to-end esophagogastric anastomosis was performed. A feeding jejunostomy tube was inserted. On the fifth postoperative day the patient's temperature rose to 38.5 °C. The anastomosis was examined by means of a diatrizoate meglumine swallow. This disclosed an 3-cm anastomotic leak with a 9×8-cm sinus tract into the mediastinum. Under radiologic control a sump