Background：Cardiac arrest due to pneumomediastinum following esophagojejunal anastomotic fistula is one of the most severe postoperative complications. However，It presents with insidious symptoms and easy to be ignored.
Case presentation: A 59-year-old man had total laparoscopic radical gastrectomy for gastric cardia adenocarcinoma (GCA). Since then, He began to appear shortness of breath and dyspnea gradually. The image reported severe pneumomediastinum due to esophagojejunal anastomotic fistula. Sudden cardiac arrest developed. Immediate cardiopulmonary resuscitation (CPR) and epinephrine rescue were carried out. Stents were placed to plug the fistula and drainage was performed.
Conclusions: Pneumomediastinum is easily overlooked as a complication of esophagojejunal anastomotic fistula after subtotal gastrectomy. A delay in diagnosis increases the rate of cardiac arrest. At present, the treatment of esophagojejunal anastomotic fistula mainly adopts conservative treatment such as drainage and interventional therapy. But the death rate is extremely high. Early positive identification is the life-saving procedure and should not be delayed.