Case Report
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 14, 2016; 22(14): 3869-3874
Published online Apr 14, 2016. doi: 10.3748/wjg.v22.i14.3869
Ileo-right hemi-colonic cervical pull-up on a non-supercharged ileocolic arterial pedicle: A technical and case report
Andreas RR Weiss, Christina Hackl, Yorick Soeder, Hans J Schlitt, Marc-H Dahlke
Andreas RR Weiss, Christina Hackl, Yorick Soeder, Hans J Schlitt, Marc-H Dahlke, Department of Surgery, University Medical Center Regensburg, 93042 Regensburg, Germany
Author contributions: Weiss ARR drafted and wrote the manuscript; Hackl C, Soeder Y and Dahlke MH drafted and critically revised the manuscript; Schlitt HJ critically revised the manuscript.
Institutional review board statement: This case report was exempt from the Institutional Review Board standards at the University Medical Center Regensburg.
Informed consent statement: The patient involved in this study gave his written informed consent authorizing use and disclosure of his protected health information.
Conflict-of-interest statement: All the authors have no conflicts of interests to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Andreas RR Weiss, MD, Department of Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93042 Regensburg, Germany. andreas1.weiss@ukr.de
Telephone: +49-941-9446801 Fax: +49-941-9446802
Received: December 12, 2015
Peer-review started: December 12, 2015
First decision: December 21, 2015
Revised: January 4, 2016
Accepted: January 30, 2016
Article in press: January 30, 2016
Published online: April 14, 2016
Processing time: 108 Days and 12.1 Hours
Abstract

Esophageal reconstruction can be challenging when stomach and colon are not anatomically intact and their use as esophageal substitutes is therefore limited. Innovative individual approaches are then necessary to restore the intestinal passage. We describe a technique in which a short stump of the right hemicolon and 25 cm of ileum on a long, non-supercharged, fully mobilized ileocolic arterial pedicle were used for esophageal reconstruction to the neck. In this case, a 65 year-old male patient had accidentally indigested hydrochloric acid which caused necrosis of his upper digestive tract. An emergency esophagectomy, gastrectomy, duodenectomy, pancreatectomy and splenectomy had been performed in an outside hospital. A cervical esophagostomy and a biliodigestive anastomosis had been created and a jejunal catheter for enteral feeding had been placed. After the patient had recovered, a reconstruction of his food passage via the left and transverse colon failed for technical reasons due to an intraoperative necrotic demarcation of the colon. Our team then faced the situation that only a short stump of the right hemi-colon was left in situ when the patient was referred to our center. After intensified nutritional therapy, we reconstructed this patient’s food passage with the right hemicolon-approach described herein. After treatment of a postoperative pneumonia, the patient was discharged from hospital on the 26th postoperative day in a good clinical condition on an oral-only diet. In conclusion, individual approaches for long-segment reconstruction of the esophagus can be technically feasible in experienced hands. They do not always require arterial supercharging or free intestinal transplantation.

Keywords: Esophageal cancer; Esophageal trauma; Esophageal reconstruction; Gastric pull-up; Colonic interposition

Core tip: Esophageal reconstructions are more challenging than usual when the stomach and the colon are not available as substitutes for esophageal replacement. In this case, hydrochloric acid had caused severe caustic injuries to the upper digestive tract requiring esophagectomy, gastrectomy, duodenectomy, pancreatectomy and splenectomy in a 65-year-old patient. The initial reconstruction failed, leaving only a short stump of the right hemicolon in situ. We then reconstructed the intestinal passage utilizing this short part of the right hemicolon and 25 cm of ileum on a long, non-supercharged, fully mobilized ileocolic arterial pedicle.