# Subxiphoid pericardial drainage for gastric tube ulcer penetrating the pericardium after esophagectomy: A case report

## TL;DR

This case report describes a novel surgical technique using subxiphoid pericardial drainage to treat a rare complication of gastric tube ulcers after esophagectomy.

## Contribution

The first reported use of subxiphoid pericardial drainage and continuous irrigation lavage for pericardial penetration from a gastric tube ulcer.

## Key findings

- Subxiphoid pericardial drainage and continuous irrigation lavage successfully treated pericardial penetration from a gastric tube ulcer.
- The technique prevented septic shock and allowed the patient to recover without complications.
- This approach may serve as an effective treatment strategy for similar rare post-esophagectomy complications.

## Abstract

Reconstructed gastric tube ulcers are common complications of esophagectomy. When the pericardium is penetrated, digestive juices can cause severe cardiac inflammation, leading to an extremely poor prognosis. We report the first case of pericardial penetration of a constructed stomach tube via the posterior mediastinal route and the first use of subxiphoid pericardial drainage and continuous irrigation lavage.

This case involved a 50-year-old woman who underwent an esophagectomy for esophageal cancer nine years prior with gastric tube reconstruction via the posterior mediastinal route. She developed pericardial penetration due to a gastric tube ulcer. Her respiratory and circulatory condition worsened, and pericardial drainage and a prophylactic tracheostomy were performed to prevent septic shock. A 5-cm longitudinal incision was made in the epigastric region, and a 4-cm T-shaped incision was made through the pericardium. Two double-lumen drainage tubes were placed in the anterior and posterior pericardium, and continuous irrigation was initiated via each tube. We successfully treated the patient without complications using subxiphoid pericardial drainage and continuous irrigation lavage, and she was discharged on postoperative day 23.

We presented this case to discuss surgical techniques and optimal treatment strategies.

Subxiphoid pericardial drainage and continuous irrigational lavage are effective for pericardial penetration of a constructed stomach tube via the posterior mediastinal route.

•Reconstructed gastric tube ulcers are common complications of esophagectomy.•Digestive juices can cause severe cardiac inflammation, with a poor prognosis.•First case pericardial penetration of stomach tube via posterior mediastinal route.•First use of subxiphoid pericardial drainage and continuous irrigation lavage.•Subxiphoid drainage and continuous lavage are effective for pericardial penetration.

Reconstructed gastric tube ulcers are common complications of esophagectomy.

Digestive juices can cause severe cardiac inflammation, with a poor prognosis.

First case pericardial penetration of stomach tube via posterior mediastinal route.

First use of subxiphoid pericardial drainage and continuous irrigation lavage.

Subxiphoid drainage and continuous lavage are effective for pericardial penetration.