Thoracic inlet located corrosive oesophageal strictures

Background Cicatricial corrosive oesophageal strictures are usually multiple and occasionally single but the thoracic inlet segment of the oesophagus being a rapid transit section is not a common site for isolated strictures. Thoracic inlet located strictures pose two major problems. First, in cases with total obstruction of the oesophagus radiological assessment even with luminal contrast fails to delineate the lower limits and real extent of the lesions. The purported single stricture in such cases becomes merely a sentinel to perhaps a coexisting rosary of strictures more distally. Secondly, the technical difficulty associated with their surgical approach is inherent in the location. The customary anterior low cervical approach is often inadequate thereby making necessary a complementary high left posterolateral thoracotomy, partial anterior mediastinotomy or hiatal approach particularly in situations where the excision of the damaged gullet is advisable.

In a series of cases treated for cicatricial corrosive stricture those with apparently isolated strictures in the thoracic inlet formed the cohort for this study. Only oesophagoscopy and contrast barium studies were available for the definition of the lesions. Treatment varied from simple resection with end to end anastomosis in seven (7) to more extended resections with gastric or colonic conduits as replacement in four (4) who had extensive cicatricial obliteration of the lumen with tubularization and rigidity of the gullet distal to the apparently solitary stricture. In some of these cases transgastric retrograde bouginage was an option for a reasonable evaluation of the luminal state of the oesophagus distal to the proximal lesion at the thoracic inlet. The reconstructive oesophageal anastomoses were all placed in the neck; none was intrathoracic.

In a series of 316 cases treated for cicatricial corrosive oesophageal strictures, 11 had isolated strictures located in the region of the thoracic inlet. Free swallowing was restored in all cases and where anastomotic leakage occurred they healed spontaneously.

Isolated corrosive oesophageal strictures in the region of the thoracic inlet are uncommon and not necessarily single. There are finite diagnostic and operative challenges inherent in their location.