A 63-year-old man undergoes subtotal oesophagectomy with gastric conduit for mid-oesophageal squamous cell carcinoma. On day 5 postoperatively, he develops tachycardia, pyrexia, and surgical emphysema in the neck. Which complication has occurred and what is the investigation of choice?
- A Anastomotic leak — confirmed by water-soluble contrast swallow or CT with oral contrast ✓
- B Chylothorax — confirmed by milky pleural fluid on chest drain
- C Aspiration pneumonia — confirmed by bronchoscopy
- D Wound infection — confirmed by wound swab culture
Correct answer: A. Anastomotic leak — confirmed by water-soluble contrast swallow or CT with oral contrast
Explanation
Anastomotic leak after oesophagectomy typically presents between days 3-7 with fever, tachycardia, sepsis, and surgical emphysema in the neck (from the cervical anastomosis site) or pleural effusion (from intrathoracic leaks). It is confirmed by water-soluble contrast swallow (gastrografin) or CT with oral contrast showing extravasation. Anastomotic leak is the most feared complication of oesophageal surgery, with mortality up to 30%. Management depends on severity — from conservative (nil by mouth, antibiotics, drainage) to endoscopic stenting or reoperation.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.