Innominate Arterial Barrier Blocked a 25-Year Substernal Neoesophagus.

Area of Science:

• Gastroenterology
• Surgical Oncology
• Thoracic Surgery

Background:

• A 67-year-old female presented with a rare complication of esophageal reconstruction.
• The patient underwent extensive upper gastrointestinal surgery at age 42 for corrosive necrosis, including esophagogastroduodenectomy and jejunectomy.
• Esophageal reconstruction was performed using an ileocolon graft via a substernal route four months post-initial surgery.

Observation:

• Twenty-five years after the initial reconstruction, the patient developed an obstruction at the proximal neoesophagus.
• The obstruction was identified as being caused by the innominate artery compressing the reconstructed esophagus.
• This rare complication, termed innominate artery-neoesophagus syndrome, presented a significant challenge to the patient's swallowing function.

Findings:

• Revision surgery was performed to alleviate the obstruction caused by the innominate artery.
• The surgical intervention successfully relieved the pressure on the neoesophagus.
• Post-revision, the patient regained the ability to consume a regular diet, indicating successful restoration of esophageal patency.

Implications:

• This case highlights the potential for late-onset complications following complex esophageal reconstructions.
• The innominate artery-neoesophagus syndrome is a critical consideration in the long-term follow-up of patients with substernal colonic interpositions.
• Timely surgical intervention can effectively manage such rare complications, significantly improving patient quality of life and nutritional status.