Fig. 1

A 59-year-old male patient with esophageal squamous cell carcinoma and esophageal obstruction. Preoperative CT showed complete obstruction of the gastric cavity by the left hepatic lobe (A). Despite insufflation of the gastric cavity, the proposed site for rectus abdominis stoma placement was still obstructed by the left hepatic lobe (B). Therefore, the decision was made to place the stoma at the left 6th intercostal space (C). A 20-G gastric wall fixator was used to secure the gastric wall (D). Following wall fixation, a 16-Fr support sheath was inserted to facilitate fistula creation, and a 15-Fr gastric catheter was inserted through the opening (E). Postoperative CT revealed minimal bleeding in the left thoracic cavity (F)