T-tube drainage and intercostals muscle flap reinforcement for the management of intrathoracic esophago-gastric anastomotic leakage with pyothorax: a case report.

We herein report a case of mediastinitis with left pyothorax due to anastomotic leakage after totally laparoscopic proximal gastrectomy (TLPG) successfully managed by T-tube placement and intercostal muscle flap reinforcement. A 51-year-old man, who had undergone a TLPG at a referring hospital, was referred for fever, elevated inflammation markers, and pleural effusion on postoperative day 3. A computed tomography (CT) scan revealed mediastinitis with left pyothorax caused by anastomotic leakage. An emergency operation was performed through a left thoracotomy. After an irrigation of the thoracic cavity and a decortication of the pleura, we found a perforation in the left side of the anastomosis. We decided to insert a T-tube through the perforation and performed intercostal muscle flap reinforcement. He got acute respiratory distress syndrome but recovered after treatment in Intensive Care Unit for 24 days. Oral intake was started on day 45 and he was discharged on day 71. A T-tube drainage and wrapping with the intercostal muscle flap is a useful choice of treatment for intrathoracic anastomotic leakage with severe inflammation.