Q) After Ivor Lewis esophagectomy, on postoperative day 5 (POD 5), bile is seen in the chest tube. The patient presents with a heart rate of 120 bpm, a temperature of 101°F, and blood pressure of 100/70 mmHg. What is the next appropriate step in management?
a) Stenting b) Colonic replacement of gastric conduit c) IV antibiotics d) Conduit excision and esophageal diversion
Correct Answer:d) Conduit excision and esophageal diversion
Rationale:
In patients who develop a completely necrotic conduit post-esophagectomy, the risk of sepsis is high. These patients often require urgent surgical intervention. Upon confirming conduit necrosis, the conduit must be resected, and the patient should undergo diversion, which includes:
End esophagostomy
Venting gastrostomy
Feeding jejunostomy
It is crucial to maintain as much length of the remaining esophagus as possible to facilitate future reconstructive procedures.
Key Points:
Postoperative Day 5: Critical time for monitoring complications after esophagectomy.
Symptoms of Concern: Tachycardia, fever, and hypotension may indicate sepsis or other complications.
Surgical Intervention: Timely recognition and management are vital for patient outcomes.
For further reading, refer to Schakelford’s Surgical Anatomy of the Gastrointestinal Tract.
