Colon interposition in a patient with total postcricoid stenosis after caustic ingestion and preservation of full laryngeal function

Abstract

Caustic burns of the upper aerodigestive tract continue to be a significant clinical problem. However, the available literature uncommonly mentions changes affecting the larynx. We could find only one publication in which four cases of high hypopharyngeal stenosis were described in detail and where the functional outcome of the laryngeal function was stated as partially saved. We describe here a case of total retrocricoid stenosis in a 28-year-old woman that was caused by lye ingestion. A life-saving gastroesophagectomy was performed by the Department of General Surgery. Reconstruction of the esophagus was carried out with mobilized right colon, which was meticulously sutured circumferentially behind the arytenoids and on the prevertebral fascia. The anatomy of the larynx and its nerve supply were scrupulously maintained intact. We believe that our patient's rehabilitation was due mainly to an intensive 18-month program of care, following which all laryngeal functions recovered with normal voice and swallowing patterns.

Circumferential Pharyngoesophageal Reconstruction and Total Larynx Preservation with Extra-anatomical Free Flaps

“…Reconstruction of pharyngeal defects with free flaps 17 is considered the first choice in oncological patients even if laryngeal preservation is performed. 14,16 Moerman et al 18,19 published a case of circumferential esophageal reconstruction with a mobilized colon, sutured behind the arytenoids, and on the prevertebral fascia, preserving the larynx. He stated that it may be better to perform a total laryngopharyngectomy and colon interposition in cases where the pharyngeal remnant is borderline for primary closure.…”

Functional Outcome Following Colon Interposition in Total Pharyngoesophagectomy with or without Laryngectomy

“…In these cases the hypopharyngeal mucosa in the postcricoid area was meticulously removed, creating a raw surface on both arytenoids and a bare prevertebral fascia at the same level. The reconstruction was then performed as described by Moerman et al [5].…”

Changes in blood protein composition under experimental chemical burns of esophageal development in rats

“…According to the American Association of Poison Control Centers, only in 2010 there were more than 1.6 million of occurrences when children used potentially hazardous chemicals, among which 18-46% of cases was using of household substances of alkaline nature (Reinberg, 2013). There are many pathologies and complications following an acid esophageal burns: swelling of the larynx, toxic shock syndrome (Dakshesh H. Parikh, 2009;Deng et al, 2008;Moerman et al, 2000), necrosis of esophageal and stomach tissue, dysmotility (Tiryaki et al, 2005), scar stricture, esophageal deformations, corrosive esophagitis, gastroesophageal reflux (Mutaf et al, 1996;Ramasamy and Gumaste, 2003), candidiasis (Zwischenberger et al, 2002), malignization in a remote period (Marzaro et al, 2006) and others.…”