# Gastropleurocutaneous fistula secondary to cement prosthesis migration: A rare late complication of chest wall sarcoma reconstruction

## TL;DR

A rare case of a fistula between the stomach and chest cavity caused by a migrated cement prosthesis used in chest wall reconstruction is reported.

## Contribution

This is the first documented case of gastropleurocutaneous fistula caused by cement prosthesis migration in chest wall sarcoma reconstruction.

## Key findings

- A 40-year-old patient developed a fistula due to erosion of a cement prosthesis into the gastric fundus.
- Surgical repair required a combined thoracoabdominal approach and diaphragmatic reconstruction.
- Long-term surveillance is needed for patients with cement-based chest wall prostheses.

## Abstract

Gastropleurocutaneous fistula (GPCF) is a rare, potentially life-threatening condition defined by an abnormal connection between the stomach and the pleural cavity with an accompanying cutaneous tract. It is distinct from a gastropleural fistula, which lacks an external cutaneous extension. To our knowledge, no prior reports have described GPCF caused by migration and erosion of a cement chest-wall prosthesis.

We present the case of a 40-year-old female with a history of anterior chest wall sarcoma resection and cement prosthesis reconstruction performed 23 years earlier. The patient developed a chronic cutaneous discharge beneath the left breast and was ultimately diagnosed with a gastropleurocutaneous fistula. Although she had experienced prior episodes of discharge, this was the first time the condition was confirmed through imaging and intraoperative findings. Imaging revealed a large left thoracoabdominal collection and erosion of the diaphragm by the prosthesis into the gastric fundus. Surgical management included isolation and stapling of the gastric fistula, diaphragmatic repair using polypropylene mesh, and pleural cavity debridement.

The development of gastropleurocutaneous fistula secondary to cement prosthesis migration has not been previously documented. While cement-based prostheses offer structural stability, long-term complications such as erosion into visceral organs may occur, particularly with inadequate fixation or soft tissue coverage. Diagnosis requires a high index of suspicion and a combination of radiological and endoscopic modalities. Surgical repair remains the definitive treatment, often requiring a combined thoracoabdominal approach.

This case highlights a rare but serious late complication of chest wall reconstruction with cement prosthesis. It underscores the need for long-term surveillance in patients with synthetic implants and the importance of individualized surgical planning in managing complex thoracoabdominal fistulas.