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Left ventriculo-colic fistula--a late complication of colonic interposition for the oesophagus
M L Pantelides1, M D Fitzgerald
1Department of Cardiothoracic Surgery, Wythenshawe Hospital, University of Manchester School of Medicine, UK.
Insights
A rare complication of colonic interposition surgery for esophageal injury is a colonic ulcer fistulating into the left ventricle. This case highlights a serious risk in patients with prior colonic esophageal substitution presenting with gastrointestinal bleeding.
Area of Science:
- Gastroenterology
- Cardiology
- Surgical Complications
Background:
- Colonic interposition is a surgical technique used for esophageal reconstruction following corrosive injury.
- Patients undergoing this procedure may face long-term complications.
- Gastrointestinal bleeding is a potential concern in patients with esophageal substitution.
Observation:
- An 18-year-old male presented with recurrent hematemesis (vomiting blood).
- This occurred 12 years after undergoing colonic interposition for corrosive esophageal injury.
- A colonic ulcer was identified near the cologastric anastomosis.
Findings:
- The colonic ulcer appeared to have fistulated directly into the left ventricle of the heart.
- This represents a previously unreported complication of colonic interposition surgery.
- The fistula formation led to significant gastrointestinal bleeding.
Implications:
- This case underscores the importance of considering rare but severe complications after colonic esophageal substitution.
- Clinicians should maintain a high index of suspicion for cardiac fistulas in patients with unexplained gastrointestinal bleeding post-surgery.
- Further investigation and awareness are crucial for managing patients with a history of colonic interposition.
Abstract:
An 18 year old man developed recurrent haematemesis 12 years after colonic interposition for corrosive injury to the oesophagus. A colonic ulcer close to the cologastric anastomosis appeared to have fistulated into the cavity of the left ventricle. This so far unreported complication needs to be considered when patients who have had coloesophageal substitution present with gastrointestinal bleeding.