However, gastric tubes that replace esophagi may erode, leading to gastric tube cancer or perforated gastric tube ulcer. Complications after gastric tube ulcer depend on the

posterior-mediastinal, retrosternal or subcutaneal location of PF-4708671 clinical trial the gastric tube. Perforated ulcers of gastric tubes in the posterior-mediastinal or retrosternal spaces, if they penetrate the neighboring trachea, thoracic aorta, or pericardium, are often lethal [1–4]. We report here a rare rescued case of pericarditis due to gastropericardial fistula of the gastric tube ulcer after esophagectomy, and review 29 cases. Case presentation A 65-year-old Japanese man was taken to National Hospital Organization Mito Medical Center by ambulance for severe colic right chest and back pain. He was lucid and body temperature was 36.7°C. His blood pressure was 127/97 mmHg, but atrial fibrillation (af), tachycardia, and ST-segment elevations in V5 and V6 were observed in the electrocardiogram (Figure 1A). Cardiomegaly was observed in the chest X-ray (Figure 1B). Severe inflammation was apparent, with a white blood cell (WBC) count of 9,100/μl and C-reactive protein (CRP) of 21.87 mg/dl (Table 1, left). He was hospitalized in the Department Z-VAD-FMK concentration of Cardiology and conservatively treated with fluid replacement and

selleck anti-biotic chemotherapies (cefazolin). His condition worsened, with WBC and CRP increasing to 12,100/μl and 30.34 mg/dl, respectively, with liver and renal dysfunction (Table 1, right). Oxygen inhalation was required for worsening respiratory dysfunction, and he entered multi organ failure (MOF). Four days after admission, computed tomography (CT) showed pneumopericardium and a neighboring gastric tube that replaced the esophagus after esophagectomy (Figure 2A, B). The patient had

a history of esophagectomy followed by reconstruction with a gastric tube via the retrosternal route for esophageal cancer 10 years previously in other hospital. One image in the whole body CT (Figure 2B) suggested the presence of a gastropericardial VAV2 fistula protruding from the gastric tube and splitting the metal staples. Upper GI endoscopy confirmed an active open ulcer that penetrated the pericardium within the gastric tube at 40 cm from the incisors (Figure 2C). Figure 1 Examination on admission: electrocardiogram (A) and chest X-ray (B). Table 1 Laboratory data on admission and four days after admission (preoperative).   On admission Four days after admission (preoperative) White blood cell (cells/μl) 9,100 12,100 Red blood cell (× 104cells/μl) 304 330 Hb (g/dl) 11.1 11.8 Hct (%) 31.2 33.9 Platelet (× 104/μl) 17.2 15.3 AST (IU/L) 7 2,480 ALT (IU/L) 6 903 ALP (IU/L) 200 237 LDH (IU/L) 147 2,000 Total bilirubin (mg/dl) 0.5 0.6 BUN (mg/dl) 25.5 64.9 Creatinine (mg/dl) 0.7 1.6 UA (mg/dl) 4.1 9.