A giant tracheogastric tube fistula caused by a penetrated peptic ulcer after esophageal replacement.

Peptic ulcers may develop in pulled-up gastric tubes used for esophageal replacement and may cause serious complications, such as perforation and hemorrhage, although they occur only rarely. We report a case in which a giant tracheogastric tube fistula was formed by penetration of a peptic ulcer into the trachea after esophageal replacement for esophageal cancer. Another ulcer developed and bled in the proximal cervical gastric tubestomy after the gastric tube diversion. Disturbed blood circulation probably was an etiological factor. Two-stage management of the fistula was advocated to save the patient.