CLOSURE OF A GASTRIC TUBE-TRACHEAL FISTULA BY TRANSPOSITION OF A PEDICLED STERNOCLEIDOMASTOID MUSCLE FLAP

We treated a 65-year-old man presenting with a gastric tube-tracheal f istula, who had undergone subtotal esophagectomy. The radiological and endoscopical findings demonstrated a 4-mm gastric tube-tracheal fistu la located just above the sternum. Conservative treatment using a flex ible fiberscope and/or gastrofiberscope, including factor XIII with fi brinogen (Beriplast P, Tisseel, and Borheal), alpha-cyanoacrylate (Aro n-alpha-A), n-butyl-2-cyanoacrylate (histoacryl), and human antihemoly tic factor XIII (Fibrogammin P) in addition to total parenteral nutrit ion with no oral intake did not result in closure of the fistula. The fistula was therefore transected and closed through an upper median st ernotomy and right partial intercostal incision followed by transposit ion of the sternocleidomastoid muscle flap between the gastric tube an d trachea. The postoperative course was uneventful.