Colonic interposition surgery after esophagectomy for lye stricture

Case contributed by Dr Jayanth Keshavamurthy

Presentation

Complaining of chest pain after lifting something heavy

Patient Data

Age: 61
Gender: Female

What is the abnormality and why?

X-ray

The right chest shows colon overlying the lungs. There are haustra to confirm these are colonic mucosal folds. There are air fluid levels in the colon. A rare surgery now a days. Right colon has been used to anastomose the esophagus proximal and stomach distally.Old tracheostomy is seen.

Can you spot the surgical connections?

CT

Right colonic interposition surgery between esophagus and stomach are shown above with anastomotic spots both proximal and distal.

Case Discussion

Patient 50 years ago underwent esophagectomy for lye ingestion 50 years ago. A right colonic interposition surgery was performed. So you see food traverses hypopharynx to right colon in thorax to stomach-duodenum-jejunum-ileum transverse colon-left colon.

Cecum is usually attached to transverse colon as a blind loop.

The right colon is reversed and the ileo cecal valve area is attached proximally to oesopahgus acting as a valve.

Usually esophagectomy is performed to reduce risk for cancer.

 

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