Gastropleural-Thoracic Fistula Secondary to Cement Prosthesis Migration: A Rare Late Complication of Chest Wall Sarcoma Reconstruction

Abstract Background Gastropleural fistula (GPF) is a rare and potentially life-threatening condition involving an abnormal connection between the stomach and the pleural cavity. Although it has been associated with trauma, malignancy, and thoracoabdominal surgery, no previous cases have reported GPF as a complication of displaced cement prosthesis following chest wall sarcoma resection. Case Presentation: We present the case of a 40-year-old Arab female with a history of anterior chest wall sarcoma resection and cement prosthesis reconstruction 23 years prior. The patient developed a chronic cutaneous discharge under the left breast and was eventually diagnosed with a gastropleural-thoracic fistula. Imaging revealed a large left thoracoabdominal collection and erosion of the diaphragm by the prosthesis into the gastric fundus. Surgical management involved gastric fistula isolation and stapling, diaphragmatic repair with mesh, and pleural debridement. Case Discussion: The development of GPF secondary to cement prosthesis migration has not been previously documented. While cement-based prostheses offer structural stability, long-term complications such as erosion into visceral organs may occur, particularly with inadequate fixation or soft tissue coverage. Diagnosis requires a high index of suspicion and a combination of radiological and endoscopic modalities. Surgical repair remains the definitive treatment, often requiring a combined thoracoabdominal approach. Conclusion This case highlights a rare but serious late complication of chest wall reconstruction with cement prosthesis. It underscores the need for long-term surveillance in patients with synthetic implants and the importance of individualized surgical planning in managing complex thoracoabdominal fistulas.