Prevention and management of complications after colon interposition for corrosive esophageal burns

Abstract

We present our experience in the management of complications after a colon interposition for corrosive esophageal burns. From April 1976 to December 2006, 85 patients with caustic esophageal burns were included in this study. The superior belly median incision with an anterior border incision of the left sternocleidomastoid was used. Anastomosis between the colon and the cervical esophagus was performed in 68 and between the colon and pharyngeal portion in 14 patients. An esophageal scar part resection and gastric-esophageal anastomosis was performed in one patient who had been given an unsuccessful colon and jejunum interposition at another institute. An anastomotic modeling operation was performed in one patient with anastomotic stricture who had been managed with colon interposition at another institute. Exploratory thoracotomy and gastrostomy was performed in one patient who had an unsuccessful colon interposition at another institute. Seven of 14 patients (8.5% of 17.1%) died with serious complications such as aspirated pneumonia, interposition colon necrosis, abdominal wound dehiscence and degradation of swallowing and concordance function. However, others with such serious complications survived and were discharged for rehabilitation after corresponding treatment. The 25 patients (30.1%) with other mild complications were discharged for rehabilitation and corresponding management. Two patients from other institutes were discharged for rehabilitation and one was lost to follow-up. The most dangerous complication of this procedure is colon necrosis, and the stomach is the best organ for re-operation. Otherwise, aspiration in infants due to hypoplasia and degradation of swallowing co-ordination needs attention. Peri-operative management is very important, including the control of mediastinal and pulmonary infection and systemic nutritional support to avoid abdominal wound dehiscence. The platysma flap is an excellent method for the treatment of anastomotic stricture.

Case Report: POST ESOPHAGECTOMY ESOPHAGEAL RECONSTRUCTION IN ESOPHAGEAL INJURY DUE TO CAUSTIC MATERIALS

“…The overall anastomosis leakage rate ranges from 20% -30% in the larger series (Yeo 2013, Boukerrouche 2013, Bassiouny & Bahnassy 1992 and does not decrease much even though the operating volume increases. In our series, the entire anastomosis leakage closes after conservative treatment, although reportedly some cases required operative management to deal with postoperative complications (Deng et al 2008).…”

Ileocolon Interposition Graft Following Surgery for Gastro-esophageal Junction Adenocarcinoma

“…No patient required reconstruction for improvement of postoperative complaint [8]. Though fistula of the cervical anastomosis is the most common postoperative complication with an incidence ranging from 6 to about 49 % [11,12], our patient did not have any anastamotic breakdown.…”

Medication-induced upper gastrointestinal tract injury

“…This type of injury is common in children27 – 31 with a mean age of 3–4 years in the largest series. Typically children ingest caustic substances accidentally, either on their own or through a caregiver.…”