PHARYNGO-ILEO-COLO-ANASTOMOSIS WITH MICRO-VASCULAR BLOOD SUPPLY AUGMENTATION FOR ESOPHAGO-GASTRIC REPLACEMENT DUE TO ESOPHAGO-GASTRIC NECROSIS AFTER CAUSTIC INGESTION

Background :

Complete esophago-gastric necrosis after caustic ingestion is a challenging surgical scenario for reconstruction of the upper digestive transit.

Aim :

To present a surgical technique for reconstruction of the upper digestive tract after total esophagectomy and gastrectomy due to esophageal and gastric necrosis

Method:

The transit was re-established by means of a pharyngo-ileo-colic interposition with microsurgical arterial and venous anastomosis for augmentation of blood supply. Colo-duodeno-anastomosis and ileo-transverse colic anastomosis were performed for complete digestive transit reconstruction.

Result:

This procedure was applied in a case of 41 years male attempted suicide by ingesting alkali caustic liquid (concentrated sodium hydroxide). Total necrosis of the esophagus and stomach occurred, which required initially total esophago-gastrectomy, closure at the level of the crico-pharyngeal sphincter and jejunostomy for enteral feeding with a highly deteriorated quality of life. The procedure was performed later and there were no major early and late postoperative complications and normal nutritional conditions were re-stablished.

Conclusion:

The procedure is feasible and must be managed by multidisciplinary team in order to re-establish a normal quality of life.