| Autor: |
Voon, Kelvin, Teoh, Keat How, Subramaniam, Karthikeashvaren, Lim, Shyang Yee, Nagalingam, Premnath |
| Předmět: |
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| Zdroj: |
Diseases of the Esophagus; Sep2018, Vol. 31 Issue 13, p59-60, 2p |
| Abstrakt: |
Background Restoration of gastrointestinal tract continuity with a suitable conduit is a vital step in esophagectomy. An adequate length of conduit, preservation of a good blood supply and functionality are keys to a successful outcome Methods We report two cases of successful ileocolonic interposition graft after esophagogastrectomy for caustic injury. Results Both patients were female with mean age of 45. They presented with progressive dysphagia and weight loss after alleged corrosive ingestion. Both had good functional status with no significant comorbidities. OGDS revealed long complex esophageal stricture and biopsy showed acute on chronic esophagitis. CT scan showed diffuse thickening of mid-distal esophagus and gastric stenosis. Both patients had refractory strictures with unsuccessful serial endoscopic dilatation. One patient had endoscopic nasoenteric tube insertion for enteral feeding while the other had laparoscopic feeding jejunostomy placed due to tight strictures. A 3-stage esophagogastrectomy with ileocolonic interposition graft was performed after optimization. Intra-operatively findings were dense fibrotic esophagus with diffuse gastric strictures. Ileocolonic graft comprising of the distal 15cm of terminal ileum, ascending colon and transverse colon was constructed based on middle colic arterial supply via marginal artery of Drummond. Vascularity and length of graft were confirmed before transection. Graft pull through was done via orthotopic posterior mediastinal route and isoperistaltic end-to-side esophago-ileocolonic anastomosis was performed at the neck. Contrast studies showed no anastomotic leak and both patients were discharged well on postoperative day 10. They had good oral intake with satisfactory weight gain with no functional disorders during follow up. Conclusion Ileocolonic interposition graft is a safe and feasible option if a gastric conduit is not available. In addition to the advantages of long length, reflux resistance and good blood supply, the smaller caliber of the ileum eases the pull through and the anastomosis due to a smaller size discrepancy. Disclosure All authors have declared no conflicts of interest. [ABSTRACT FROM AUTHOR] |
| Databáze: |
Complementary Index |
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