Stenosis of the Esophagus in Cicatricial Pemphigoid Resolved by colon Interposition: Report of a Case

Abstract

We present herein the exceedingly uncommon case of a patient with cicatricial pemphigoid (CP) who gradually developed conjunctival, oral, and esophageal involvement. Despite long-term medical management with dapsone and disulone, the ocular lesions progressed to produce further scarring, which led to ankyloblepharon, symblepharon, and ultimately, blindness of the right eye. After a period of 5 years the patient developed a total esophageal stricture, intractable by dilation, necessitating esophageal reconstruction. The details of an original procedure using a continuous colic loop are described, highlighting the better tolerance of this technique by a high-risk patient. A discussion on the recent advances in diagnosing bullous dermatoses is presented following this case report.

Esophageal involvement in cicatricial pemphigoid: a rare cause of dysphagia

“…4,13 Colonic interposition has also been used for refractory dysphagia. 3 In this patient, graded esophageal dilatation was very successful, with an improvement of dysphagia score after only three sessions. The benefit was sustained for over 6 months (at the last follow-up).…”

“…Reports of bullae formation, mucosal injury and even perforation, however, have been documented 4,13 . Colonic interposition has also been used for refractory dysphagia 3 …”

“…Colonic interposition has been described in refractory cases. 3 We describe a case of cicatricial pemphigoid with esophageal involvement and difficulties in therapy.…”

A new philosophy in esophageal reconstruction with colon. Thirty-years experience

“…The pathological conditions demanding esophagocoloplasty in this series are: corrosion in 284 patients, malignancy in 54 patients, reflux esophagitis in four patients, infection in three patients, trauma in one patient and leiomyoma in one patient. The post‐infection strictures were caused by Behçet's disease, diphtheritic croup and pemphigus 12 . Left colon interposition with blood supply provided by the left colic artery was used in 155 patients and by the right colic artery in 91 patients.…”

“…The post-infection strictures were caused by Behçet's disease, diphtheritic croup and pemphigus. 12 Left colon interposition with blood supply provided by the left colic artery was used in 155 patients and by the right colic artery in 91 patients. The ascending colon with blood supply provided by the right colic artery was performed in 43 patients and by the ileocolic artery in one patient.…”