Successful management of therapy-refractory pseudoachalasia after Ivor Lewis esophagectomy by bypassing colonic pull-up: A case report

Figure 1 Endoscopic examination revealed a scar stricture of the esophago-gastrostomy with prestenotic dilatation of the remnant esophagus. Tumor recurrence or anastomotic leakage-induced anastomotic stenosis could not be identified.

Figure 2 Progressive anastomotic stricture despite recurrent endoscopic balloon dilatations resulted in increased clinical symptoms such as regurgitation and vomiting.

Figure 3 Schematic illustration of restoring gastrointestinal continuity after colonic pull-up (arrow). Gastric pull-up (*) is still localized in the posterior mediastinum after dissection of esophago-gastrostomy. (Figure was created with the support of SMART Servier Medical Art, smart.servier.com).

Figure 4 Postoperative esophageal barium swallow examination shows a normal gastrointestinal passage without food retention or anastomotic leakage.

Figure 5 Postoperative computed tomography images. Postoperative computed tomography scan demonstrates gastric pull-up (*) placed in the posterior mediastinum and the retrosternal localized colonic pull-up (arrow) without compromising patient´s cardiopulmonary status.