Intraluminal Migration of Surgical Drains After Transhiatal Esophagogastrectomy: Radiographic Findings and Clinical Relevance
Andrew S. H. Wilmot1,
Marc S. Levine1,
Stephen E. Rubesin1,
John C. Kucharczuk2 and
Igor Laufer1
1 Department of Radiology, Hospital of the University of Pennsylvania, 3400
Spruce St., Philadelphia, PA 19104.
2 Department of Surgery, Hospital of the University of Pennsylvania,
Philadelphia, PA.
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Fig. 1A —62-year-old woman who underwent esophagogastrectomy and
gastric pull-through. Follow-up studies showed intraluminal migration of
surgical drain through esophagogastric anastomosis into proximal intrathoracic
stomach and subsequent development of anastomotic stricture. Left posterior
oblique spot image from index upper gastrointestinal study with water-soluble
contrast agent shows tip of drain as intraluminal filling defect
(large black arrow) in proximal intrathoracic stomach with
contrast agent entering drain (small black arrows),
indicating leak. Note how distal end of drain overlies lumen of proximal
intrathoracic stomach. Esophagogastric anastomosis is denoted by white
arrow.
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Fig. 1B —62-year-old woman who underwent esophagogastrectomy and
gastric pull-through. Follow-up studies showed intraluminal migration of
surgical drain through esophagogastric anastomosis into proximal intrathoracic
stomach and subsequent development of anastomotic stricture. Right posterior
oblique (RPO) spot image from same examination as A again shows
surgical drain entering proximal intrathoracic stomach through esophagogastric
anastomosis (white arrow). Note how distal end of drain (black
arrows) also overlies lumen in this projection.
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Fig. 1C —62-year-old woman who underwent esophagogastrectomy and
gastric pull-through. Follow-up studies showed intraluminal migration of
surgical drain through esophagogastric anastomosis into proximal intrathoracic
stomach and subsequent development of anastomotic stricture. RPO spot image
from repeat upper gastrointestinal study obtained with barium 2 weeks after
A and B shows complete healing of leak after removal of drain.
However, 5-mm-wide stricture is now seen at esophagogastric anastomosis
(white arrow). Surgical clips abutting anastomosis are denoted by
black arrows.
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Fig. 2A —65-year-old man who underwent esophagogastrectomy and gastric
pull-through. Follow-up studies showed intraluminal migration of surgical
drain through esophagogastric anastomosis into proximal intrathoracic stomach.
Right posterior oblique (RPO) spot image from upper gastrointestinal study
with barium (water-soluble contrast agent failed to reveal leak) shows small
leak from left lateral aspect of esophagogastric anastomosis into 7-mm
sealed-off collection (arrow) abutting anastomosis. Although surgical
drain is not visible on this image, it had not yet migrated into lumen.
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Fig. 2B —65-year-old man who underwent esophagogastrectomy and gastric
pull-through. Follow-up studies showed intraluminal migration of surgical
drain through esophagogastric anastomosis into proximal intrathoracic stomach.
Left posterior oblique spot image from repeat upper gastrointestinal study
with water-soluble contrast agent 1 week after A shows surgical drain
entering proximal intrathoracic stomach through esophagogastric anastomosis
(large white arrow) at site of previous leak. Distal end of
drain is barely visible as filling defect overlying lumen (black
arrows). Contrast agent is seen leaking from anastomosis through and
around drain (small white arrow).
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Fig. 2C —65-year-old man who underwent esophagogastrectomy and gastric
pull-through. Follow-up studies showed intraluminal migration of surgical
drain through esophagogastric anastomosis into proximal intrathoracic stomach.
RPO spot image from same examination as B again shows drain entering
proximal intrathoracic stomach through esophagogastric anastomosis
(large white arrow) at site of previous leak. Note how
distal end of drain (black arrow) also overlies lumen in this
projection. Contrast agent is seen in drain (small white
arrows), indicating leak.
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Fig. 3A —65-year-old man who underwent esophagogastrectomy and gastric
pull-through. Follow-up studies showed intraluminal migration of surgical
drain through esophagogastric anastomosis into proximal intrathoracic stomach
with large postoperative leak and subsequent development of anastomotic
stricture. Left posterior oblique spot image from index upper gastrointestinal
study with water-soluble contrast agent shows drain entering proximal
intrathoracic stomach through esophagogastric anastomosis (large
black arrow). Leak is seen extending from region of drain into large
collection (white arrows) in mediastinum abutting left lateral aspect
of intrathoracic stomach. Also note contrast agent in drain (small
black arrow).
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Fig. 3B —65-year-old man who underwent esophagogastrectomy and gastric
pull-through. Follow-up studies showed intraluminal migration of surgical
drain through esophagogastric anastomosis into proximal intrathoracic stomach
with large postoperative leak and subsequent development of anastomotic
stricture. Frontal spot image from repeat upper gastrointestinal study with
water-soluble contrast agent 2 weeks after A shows marked healing of
leak with small residual extraluminal collection (white arrows) in
adjacent mediastinum. Original drain had been removed and replaced by pigtail
catheter, which has also migrated through esophagogastric anastomosis
(large black arrow) into lumen of proximal intrathoracic
stomach. Note how end of catheter (small black arrow)
overlies lumen.
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Fig. 3C —65-year-old man who underwent esophagogastrectomy and gastric
pull-through. Follow-up studies showed intraluminal migration of surgical
drain through esophagogastric anastomosis into proximal intrathoracic stomach
with large postoperative leak and subsequent development of anastomotic
stricture. Steep right posterior oblique (RPO) spot image from same
examination as B shows distal end of catheter entering proximal
intrathoracic stomach through anastomotic region (large white
arrow). Note small residual leak (small white arrows)
from anastomosis at site of entry of catheter into lumen. Distal end of
catheter (black arrows) also overlies lumen of intrathoracic stomach
in this projection.
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Fig. 3D —65-year-old man who underwent esophagogastrectomy and gastric
pull-through. Follow-up studies showed intraluminal migration of surgical
drain through esophagogastric anastomosis into proximal intrathoracic stomach
with large postoperative leak and subsequent development of anastomotic
stricture. RPO spot image from another follow-up upper gastrointestinal study
with water-soluble contrast agent 2 months after B and C shows
complete healing of leak, with development of 3-mm-wide stricture
(arrow) at esophagogastric anastomosis. Note that catheter has been
removed.
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Copyright © 2007 by the American Roentgen Ray Society.
