Intussusception of a transferred jejunal flap in cervical esophagus reconstruction.
Although jejunal flaps have been used frequently for esophageal reconstruction, and the techniques for transfer, as well as subsequent modification, have been well described, a variety of complications still poses problems for both physicians and patients. The challenge exists in avoidance and management of complications. The purpose of this report is to present an unusual but severe complication involving a jejunal flap that was transferred to the neck for esophageal reconstruction. Intussusception of the jejunal flap occurred 1 year after flap transfer due to redundancy of the transferred segment. The patient was a child who had esophageal reconstruction for severe dysphagia that was due to a previous history of radiation injury. The disorder was successfully treated surgically with manual reduction of the intussuscepted segment, followed by shortening of the jejunal flap to prevent future recurrence. One should keep in mind that redundancy of the reconstructed esophagus may cause dysphagia due to kinking or, in this case, intussusception, which may result in necrosis of a segment of the transferred jejunum. One of the measures that should be taken during the initial reconstruction to prevent these serious complications is to perform the final inset of the jejunal flap after revascularization. This allows for proper assessment of jejunal length, which undergoes a significant change after restoration of the vascular supply.
Ozkan
Omer
O
Department of Plastic and Reconstructive Surgery, E-Da Hospital/I-Shou University, 1 E-Da Road, Jiau-shu Tsuen, Yan-chau Shiang, Kaohsiung County, Taiwan 824, ROC. omozkan@hotmail.com
Chen
Hung-Chi
HC
Cigna
Emanuele
E
Mardini
Samir
S
Salgado
Christopher J
CJ
Lai
Hsing-Kuang
HK
Liu
Yi-Tien
YT
D002648:Child; D004945:Esophagoscopy; D004947:Esophagus / Q000601:surgery*; D006801:Humans; D007583:Jejunum / Q000637:transplantation*; D008297:Male; D011183:Postoperative Complications / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps