Anastomotic leakage has been responsible for 29% to 44% of the deaths after esophagogastrectomy.1 When anastomotic leakage does occur, the associated mortality ranges from 44% to 93%.2 The patient described here had an anastomotic leak develop after esophagogastrectomy; the leak was not apparent until bilirubin crystals were discovered in pleural fluid.
Report of a Case.—A 65-year-old man had dysphagia. A barium esophagram showed a lesion in the distal third of the esophagus and the results of esophagoscopy with biopsy were interpreted as showing adenocarcinoma. The patient underwent esophagogastrectomy and gastroesophageal anastomosis through a left thoracoabdominal approach, and a tube was inserted in the chest for drainage. An upper gastrointestinal fluoroscopic series on the sixth post-operative day revealed a widely patent gastroesophageal anastomosis. The next morning, severe right-sided back pain, diaphoresis, tachycardia, and progressive dyspnea developed. There was no increased drainage from the tube in the left side
BURT ME, LONG JA, FLYE MW. Bilirubin Crystals in Pleural Fluid. Arch Surg. 1980;115(5):677. doi:10.1001/archsurg.1980.01380050097028