Published online Apr 14, 2016. doi: 10.3748/wjg.v22.i14.3869
Peer-review started: December 12, 2015
First decision: December 21, 2015
Revised: January 4, 2016
Accepted: January 30, 2016
Article in press: January 30, 2016
Published online: April 14, 2016
Processing time: 108 Days and 12.1 Hours
Esophageal reconstruction can be challenging when stomach and colon are not anatomically intact and their use as esophageal substitutes is therefore limited. Innovative individual approaches are then necessary to restore the intestinal passage. We describe a technique in which a short stump of the right hemicolon and 25 cm of ileum on a long, non-supercharged, fully mobilized ileocolic arterial pedicle were used for esophageal reconstruction to the neck. In this case, a 65 year-old male patient had accidentally indigested hydrochloric acid which caused necrosis of his upper digestive tract. An emergency esophagectomy, gastrectomy, duodenectomy, pancreatectomy and splenectomy had been performed in an outside hospital. A cervical esophagostomy and a biliodigestive anastomosis had been created and a jejunal catheter for enteral feeding had been placed. After the patient had recovered, a reconstruction of his food passage via the left and transverse colon failed for technical reasons due to an intraoperative necrotic demarcation of the colon. Our team then faced the situation that only a short stump of the right hemi-colon was left in situ when the patient was referred to our center. After intensified nutritional therapy, we reconstructed this patient’s food passage with the right hemicolon-approach described herein. After treatment of a postoperative pneumonia, the patient was discharged from hospital on the 26th postoperative day in a good clinical condition on an oral-only diet. In conclusion, individual approaches for long-segment reconstruction of the esophagus can be technically feasible in experienced hands. They do not always require arterial supercharging or free intestinal transplantation.
Core tip: Esophageal reconstructions are more challenging than usual when the stomach and the colon are not available as substitutes for esophageal replacement. In this case, hydrochloric acid had caused severe caustic injuries to the upper digestive tract requiring esophagectomy, gastrectomy, duodenectomy, pancreatectomy and splenectomy in a 65-year-old patient. The initial reconstruction failed, leaving only a short stump of the right hemicolon in situ. We then reconstructed the intestinal passage utilizing this short part of the right hemicolon and 25 cm of ileum on a long, non-supercharged, fully mobilized ileocolic arterial pedicle.