A case of gastropericardial fistula of a gastric tube after esophagectomy: a case report and review

A 65-year-old man who had received an esophagectomy 10 years earlier was admitted to our hospital for right chest pain. Preoperative examinations showed pneumopericardium, a retrosternal gastric tube, and an active gastric tube ulcer. We diagnosed gastropericardial fistula of the gastric tube ulcer. Emergency surgery included lavage and drainage of the pericardial cavity and plombage of the rectus abdominis muscle flap to the posterior space of the gastric tube. Total parental nutrition and/or enteric nutrition were provided. Due to minor leakage from the ulcer, the patient could start oral intake on the postoperative 49th day, and was discharged from the hospital on the postoperative 86th day after physical rehabilitation. He has been free from complications for more than 33 months after surgery. Here, we review the literature and discuss the etiology and treatment of choice for this rare yet lethal complication in the follow-up after esophagectomy

Modeling elastic lamina buckling in the unloaded aortic media

Mathematical modeling of the thoracic aorta is important for detecting extraordinary and unusual stress or strain distributions of the hypertensive aortic wall, even in early stages, and for understanding the development and progression of various cardiovascular diseases. In a freshly isolated aortic media, which mainly comprises elastic laminas (ELs) and smooth muscle layers (SMLs), circumferential EL waviness and longitudinal EL undulation are often observed because of the buckling of ELs, which is closely associated with residual stresses of ELs and SMLs in the aortic wall. However, the mechanism underlying EL buckling or specific mechanical interactions between EL and SML remains unclear. We hypothesized that the longitudinal EL undulation is likely formed by the superposition of the circumferential EL waviness along the aortic axis. Hence, a series of numerical simulations were conducted based on a design of experiments approach by implementing residual stresses. We identified that the prestress initially administered to ELs in the circumferential and axial directions, and the predefined internodal gap, which couples the EL and SML, are essential mechanical parameters to computationally reconstruct the circumferential EL waviness and the longitudinal EL undulation at an unloaded state. In addition, a mechanical balance between the assigned prestresses along the circumferential and axial directions is crucial for successful representation of structural buckling of EL in the unloaded aortic media. Although further study is required, we have verified that our hypothesis is reasonable in the current work. Moreover, the information we obtained here will greatly help improve understanding the roles of EL and SML in the aortic medial wall at the in vitro and in vivo states, while simultaneously providing a basis for more sophisticated computational modeling of the aorta