Ryan M Juza, MD, Tung T Tran, MD, Eric M Pauli, MD. Penn State Milton S. Hershey Medical Center.
Transabdominal tube drainage is a well described surgical technique for drainage of a blind-ending luminal structure particularly in the emergent setting. A potentially serious complication of transabdominal drainage includes dislodgement of the tube leading to free perforation and sepsis with an associated high morbidity and mortality. Methods described in the literature for rescuing or repairing dislodged transabdominal drainage tubes includes open, laparoscopic, and more recently natural orifice translumenal endosurgical (NOTES) techniques. We report the case of a dislodged transabdominal esophagostomy tube in the late postoperative period of a patient who had previously undergone total gastrectomy for full-thickness gastric necrosis. A NOTES approach was utilized combined with a modified percutaneous endoscopic gastrostomy technique for exchange of a new esophagostomy drainage tube through the original tract. There were no intraoperative complications and the tube functioned appropriately postoperatively. The patient tolerated the procedure well and was discharged home on postoperative day 1. He required esophagostomy tube repositioning 5 months postop which was managed under fluoroscopy. The patient otherwise did well and went on to have a total reconstructive surgery at 1 year post op. We believe this case report demonstrates a novel use of NOTES technique for the minimal access management of a transabdominal drainage tube complication in a complicated patient.