Oesophageal replacement in adult Nigerians with corrosive oesophageal strictures

Literature dealing with the management of undilatable oesophageal strictures in Africa is either scanty or non-existent. This report reviews 73 cases of adult undilatable corrosive strictures treated by oesophageal replacement at the University of Nigeria Teaching Hospital (UNTH) Enugu over a 5-year period (March 1986 to February 1991). Almost all the cases were suicidal or parasuicidal. All the patients had colon transplants; the right colon was used in 68 patients while the left colon was used in five patients. The age range was 13 to 48 years with a mean of 26 years. There were 65 males and 8 females. Four patients died in the postoperative period, earlier on in our surgical experience, a mortality of 5%. Of the 69 survivors, 62 patients (90%) experienced no dysphagia after 6-9 months of follow-up. Four patients (6%) swallowed with some difficulty while three patients who could not swallow at all 6 months after surgery underwent further surgery, the strictured upper part of the transplants being replaced with myocutaneous tube grafts after which two patients were able to swallow. Major postoperative complications were proximal anastomotic leak 49% (34 patients) of survivors, wound sepsis 25% (17 patients), tension pneumothorax 7% (five patients), colon graft necrosis 4% (three patients), and Ascaris upper intestinal obstruction 4% (three patients). The short and medium term results after colon transplant for oesophageal corrosive strictures are good. Our experience emphasizes the fact that these patients are from the very low social class, usually ignorant and most default at the follow-up clinics, once they start swallowing.(ABSTRACT TRUNCATED AT 250 WORDS)