Published online Jul 26, 2022. doi: 10.12998/wjcc.v10.i21.7609
Peer-review started: March 17, 2022
First decision: May 9, 2022
Revised: May 18, 2022
Accepted: June 15, 2022
Article in press: June 15, 2022
Published online: July 26, 2022
Processing time: 115 Days and 21.5 Hours
Gastrografin swallow, methylthioninium chloride test, and computed tomography (CT) are the main methods for postoperative anastomotic fistula detection. Correct selection and application of examinations and therapies are significant for the early diagnosis and treatment of small anastomotic fistulas after radical gastrectomy, which are conducive to postoperative recovery.
A 44-year-old woman underwent radical total gastrectomy for laparoscopic gastric cancer. The patient developed a fever after surgery. The methylthioninium chloride test and early CT suggested no anastomotic fistula, but gastrografin swallow and late CT showed the opposite result. The fistula was successfully closed using an endoscopic clip. The methylthioninium chloride test, gastrografin, and CT performed on different postoperative dates for small esophagojejunostomy fistulas are different. The size of the anastomotic fistula is an important factor for the success of endoscopic treatment.
The advantages and limitations of the diagnosis of different examinations of small esophagojejunostomy fistulas are noteworthy. The size of the leakage of the anastomosis is an important basis for selecting the repair method.
Core Tip: Gastrointestinal anastomotic fistula is one of the major complications after gastrointestinal anastomosis. The early diagnosis of small anastomotic fistulas and the choice of treatment are particularly important. We reported a case of a gastrointestinal anastomotic fistula that was not easily diagnosed at an early stage and discussed the advantages and limitations of the current main methods of examination in the context of medical imaging. In addition, we discussed the appropriate treatment for different anastomotic fistulas.