Closure of a gastric tube-tracheal fistula by transposition of a pedicled sternocleidomastoid muscle flap.

We treated a 65-year-old man presenting with a gastric tube-tracheal fistula, who had undergone subtotal esophagectomy. The radiological and endoscopical findings demonstrated a 4-mm gastric tube-tracheal fistula located just above the sternum. Conservative treatment using a flexible fiberscope and/or gastrofiberscope, including factor XIII with fibrinogen (Beriplast P, Tisseel, and Borheal), alpha-cyanoacrylate (Aron-alpha-A), n-butyl-2-cyanoacrylate (histoacryl), and human antihemolytic factor XIII (Fibrogammin P) in addition to total parenteral nutrition with no oral intake did not result in closure of the fistula. The fistula was therefore transected and closed through an upper median sternotomy and right partial intercostal incision followed by transposition of the sternocleidomastoid muscle flap between the gastric tube and trachea. The postoperative course was uneventful.