Gastropleural Fistula: A Rare Complication of Ewing Sarcoma
A 30-year-old man was admitted to our clinic with complaints of abdominal pain and fever. He had a history of Ewing's sarcoma diagnosed 18 months earlier on his chest wall and he had undergone pneumectomy with negative excision margins, followed by chemotherapy. On physical examination, the patient had decreased breath sounds on his left hemithorax and tympanic percussion. His saturation was 91% despite oxygen treatment given at a 10-1/min rate through an oxygen mask. After oral administration of methylene blue, leakage of the substance from the thoracic tube was detected. A contrast-enhanced computed tomography and barium study showed a gastropleural fistula between the stomach and the thorax. Gastroscopy confirmed the diagnosis of a fistula, with a massive amount of pus coming from the thorax. Treatment with ampicillin/sulbactam and fasting relieved his abdominal pain and fever. After oral feeding was started, his symptoms worsened; therefore, the patient was administered parenteral nutrition. Since the conservative treatment failed, the patient underwent laparoscopic surgery. The gastropleural fistula was in the greater curvature of the stomach in the fundic area. Wedge resection of the fistula was performed by three trocars and a 60 GIA stapler (Ethicon Endo-Surgery, Cincinnati, OH, USA), and the diaphragm was repaired with a prolene graft. The thoracic tube was extracted on the second postoperative day, and the patient was discharged on the fifth postoperative day. Pathologic evaluation of the specimen demonstrated the recurrence of Ewing's sarcoma, which may have played a role in the formation of the gastropleural fistula.