Q) After Ivor Lewis esophagectomy, on POD 5 , bile is seen in chest tube. Patient's heart rate is 120, temp is 101 degree F, BP is 100/70. What will be the next step?
a) Stenting
b) Colonic replacement of gastric conduit
c) IV antibiotics
d) Conduit excision and Esophageal diversion
Ans d
Patients with a completely necrotic conduit are most often septic and brought to the operating room for emergent exploration.
If conduit necrosis is confirmed, then the conduit must be resected and the patient
should be diverted with an end esophagostomy, venting gastrostomy, and feeding jejunostomy. Care should be
taken to maintain the longest possible length of remaining
esophagus to facilitate future reconstruction
