A Case of Perforation of the Membranous Trachea after Esophagectomy with Recovery through Repair of the Muscle Valves and Devised Airway Management

Abstract

A 65-year old man was diagnosed with esophageal cancer cStage II and underwent neoadjuvant chemotherapy and subtotal esophagectomy. Anastomostic leakage was observed on postoperative day (POD) 7, and blood sampling revealed a marked increase in inflammatory reaction on POD 10. Chest CT revealed pleural effusion in the right thoracic cavity and empyema was diagnosed. Bronchoscopy revealed three perforations of the membranous trachea on POD 14, and emergency surgery was conducted for cervical esophagostomy, exclusion of the gastric tube, and fenestration. After this surgery, differential lung ventilation was performed with a double lumen tube and two ventilations. The perforations epithelized and extubation was possible 44 days after the emergency operation. Thoracoplasty was performed on POD 94 (after the initial surgery), followed by esophageal reconstruction by free jejunal autograft on POD 153. The patient was discharged on POD 196. We report this case as an example of a successful surgical strategy and postoperative management for perforation of the membranous trachea.