Subacute ischemia of the colon esophageal interposition

The most devastating complication of colon interposition is acute ischemia with colon necrosis. Delayed complications of the interposed colon, including long segment stricturing develop in an occasional patient. Some investigators have speculated that these late complications result from delayed colon ischemia. We believe that these patients represent a small subgroup who have nonnecrotic vascular insufficiency (subacute ischemia) of the interposed colon, which is present from the time of the operation. We reviewed the postoperative contrast radiographic studies of 3 patients with subacute colon ischemia. The radiographic findings are characteristic, and are identical to those seen in ischemic colitis of the nonmobilized colon. They include loss of haustral folds, an ill-defined bowel wall border, and mucosal changes such as "thumbprinting," and "urticaria." Fibrosis and stricturing represent the end-stage of the ischemic process.