Intraluminal migration of a surgical drain near an anastomosis site after total gastrectomy

Background: Esophagojejunal anastomotic leakage (EJAL) is a severe complication following gastrectomy for gastric cancer, typically treated with drainage and nutritional support. We report a case of intraluminal drain migration near the esophagojejunal anastomosis (EJA), resulting in persistent drainage and mimicking EJAL after total gastrectomy. Case summary: A 64-year-old male underwent open total gastrectomy with Roux-en-Y reconstruction for gastric adenocarcinoma, with two silicone drains placed near the EJA. On postoperative day (POD) 4, the patient developed signs of peritonitis and sepsis, necessitating surgical re-exploration abscess drainage, peritoneal lavage, and drain repositioning. A contrast swallow study on POD 18 revealed rapid filling of the abdominal drain without extraluminal contrast collection. Persistent drainage prompted an upper gastrointestinal endoscopy on POD 59, which revealed approximately 5 cm of the drain within the esophagus, with the perforation site located 2 cm distal to the intact EJA. The drain was repositioned under endoscopic guidance. A repeat contrast radiograph on POD 67 demonstrated no evidence of extraluminal contrast extravasation or filling of the abdominal drain. The patient was subsequently discharged without further incident. Conclusion: Intraluminal drain migration is a rare complication following gastric surgery but should be considered when persistent drainage occurs.