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Successful Management of a Perforated Interposed Substernal Ileocolon Caused by Right Pleural Hernia

Atsushi Shiozaki1, Hitoshi Fujiwara1, Hirotaka Konishi1

  • 1Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.

The Annals of Thoracic Surgery
|December 24, 2015
PubMed

Insights

A rare complication following esophageal reconstruction using ileocolon interposition occurred, involving a pleural hernia and cecal perforation. Surgical repair successfully preserved the reconstructed organ, highlighting technique importance.

Area of Science:

  • Gastroenterology
  • Thoracic Surgery
  • Surgical Reconstruction

Background:

  • Esophagectomy with ileocolon interposition is a reconstructive technique used after esophageal removal.
  • Substernal esophageal reconstruction aims to restore gastrointestinal continuity and function.
  • Complications can arise from the surgical technique and the choice of graft material.

Observation:

  • A 73-year-old male presented with acute right-sided chest pain post-vomiting, 10 months after esophagectomy and ileocolon reconstruction.
  • Emergency surgery identified a right pleural hernia of the esophageal substitute and a 3-cm cecal perforation.
  • The complication occurred within the substernal tract used for the ileocolon graft.

Findings:

  • The cecal perforation was directly sutured.
  • Redundant ileum was straightened, and the repaired cecum was repositioned into the abdominal cavity.
  • This maneuver prevented intrathoracic leakage and preserved the reconstructed esophagus.

Implications:

  • This case highlights a rare but serious complication of ileocolon esophageal reconstruction.
  • Meticulous pleural dissection and appropriate ileocolon graft length are crucial for preventing such adverse events.
  • Successful management underscores the importance of surgical technique in long-term outcomes of esophageal reconstruction.

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