Strangulation of the reconstructive gastric tube by the azygos arch

Graft necrosis after esophageal reconstruction is a rare but disastrous complication associated with a high mortality rate. Azygos arch strangulation of the graft is an unusual cause of graft necrosis. We report two cases of postesophagectomy gastric tube reconstruction complicated by azygos arch strangulation and graft ischemia. In one patient, graft necrosis resulted and a reconstruction was performed later with a colon interposition. In the other patient, the azygos arch was divided and the graft was preserved. We recommend dividing the azygos arch routinely during transthoracic or thoracoscopic esophagectomy if the reconstruction graft is to be brought up through the posterior mediastinal route to help avoid this problem.