Successful treatment of tracheomediastinal fistula after tracheal injury obtained during esophagectomy using the pectoralis major muscle: A case report

When tracheal injury occurs during esophagectomy, it is a very serious and frequently fatal complication. We experienced a case of intractable tracheomediastinal fistula caused by tracheal injury during esophagectomy that was successfully repaired using a pedicle flap of the left pectoralis major muscle. A 55-year-old Japanese man who had congenital right aortic arch was referred to our hospital with a complaint of dysphagia. He had a type 2 carcinoma from the distal part of the cervical esophagus to the upper thoracic esophagus, 4.5 cm in length and attached to the membranous wall of the trachea. Subtotal esophagectomy was performed with left thoracotomy. The tumor adhered tightly to the membranous portion of the trachea, and the trachea was injured during removal of the tumor. The laceration was directly sutured and covered with a latissimus dorsi muscle flap. However, a tracheomediastinal fistula became enlarged and the left subclavian artery became exposed. Repair of the fistula was performed 31 days after the first operation: a permanent tracheotomy was made, laryngectomy was performed, and the fistula was filled with a pedicle flap of the pectoralis major muscle. The postoperative course was uneventful and the patient's general condition improved. The use of a pectoralis major muscle flap was effective for repairing the tracheomediastinal fistula.