식도암으로 식도 절제술 및 위 식도문합술 후 합병증으로 발생한 위심막루
A Case of Gastropericardial Fistula as a Complication after Esophagectomy with Esophagogastrostomy for Esophageal Cancer
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초록
위심막루 및 심막기종은 드물 뿐 아니라 종종 치명적인 결과를 초래하는데 가장 흔한 원인으로는 양성 위궤양을 들 수 있으며, 그외 열공성 탈장의 재건, 위저추벽성형술 및 악성 위궤양, 그리고 드물게 위 또는 식도 절제술 후 흉강내 위전위 등이 있다. 1년 6개월 전 식도암으로 하부식도 절제술 및 위 식도문합술 후 흉골하 통증으로 내원한 60세 남자 환자에서 합병증으로 발생한 위심막루를 경험하였기에 문헌고찰과 함께 보고한다.
Abstract
The gastric pedicle is commonly used for the reconstruction following the resection of esophageal cancer. We recently experienced a case in which gastric ulcer occurred eighteen months postoperatively. A 60 year-old man complaining of chest pain, dry cough, mild fever and chills was admitted to the emergency room. The patient had a history of esophagectomy and esophagogastrostomy because of esophageal cancer. Chest X-ray and CT scan showed pneumopericardium. Upper GI contrast study showed a fistulous tract between the stomach pedicle and the pericardium. Upper GI endoscopy showed beating heart through the fistulous opening. The patient expired with sepsis on the twenty second days after an emergent operation. Gastropericardial fistula caused by a peptic ulcer perforation after the esophgectomy and esophagogastrostomy operation is a very rare complication and brings a fatal result. Early detection using the chest radiography, electrocardiogram, echocardiography, upper GI study and physical examination, and an immediate treatment are therefore mandatory.
참고문헌 (18)
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