Air Leak Conundrum following Oesophagectomy: A Case Report and Review of Literature

Abstract

Oesophagectomy is an established technique for treating oesophageal cancer. Pulmonary complications during the postoperative period can arise from intraoperative manipulation, thoracic structure injury, or anastomotic leaks. At our institution, it is standard practice to place a soft corrugated drain around the anastomosis in the neck to facilitate the drainage of any anastomotic leakage towards the skin. In this case report, a 55-year-old female underwent video-assisted oesophagectomy in the prone position after neoadjuvant chemoradiation. A corrugated drain was subsequently placed near the anastomosis site in the neck. On the third day postoperatively (POD 3), she developed a sudden pneumothorax and an air leak in the chest tube. Despite the placement of a second intercostal tube and normal findings on fibreoptic bronchoscopy, the air leak persisted. Unexpectedly, the air leak spontaneously ceased, and the lungs re-inflated after 24 hours. Upon analysis, it was discovered that the dressing over the neck drain, which had been changed on POD 3, did not completely cover the wound. This, combined with malpositioning, created a oneway valve effect, leading to pneumothorax. Therefore, the use of a corrugated neck drain following oesophagectomy may result in life-threatening pneumothorax and should either be airtight sealed with dressing or avoided.