title: Subcutaneous esophagojejunal reconstruction in the management of esophagogastric anastomotic leak: a staged procedure.
abstract: Rupture of the esophagogastric anastomosis is potentially lethal if untreated. We report a case of esophagogastrostomy disconnection after an upper partial gastrectomy for strangulated paraesophageal hernia. The patient, a 50-year-old woman, developed systemic sepsis due to rapid manifestation of suppurative mediastinitis followed by peritonitis and was admitted to the intensive care unit 8 days after the primary operation. The patient underwent a staged surgical treatment and survived after a prolonged hospital stay. Initial reoperation consisted of emergent laparotomy and right thoracotomy for drainage and debridement completed with excision of the anastomosis, gastric stump exclusion and subcutaneous presternal transposition of the esophagus performed through a left cervical incision. Delayed restoration of the continuity of the gastrointestinal tract was re-established using jejunum. The final result achieved was a successful esophagojejunal anastomosis with both organs transposed in a subcutaneous presternal canal. The patient regained normal swallowing function. The 'subcutaneous esophageal transposition' procedure enables the easy performance of an extrathoracic esophagojejunal anastomosis and results in a safe gastrointestinal tract reconstruction in cases with esophagogastric anastomotic leakage.
authors.affiliation: Second Department of Surgery, District General Hospital Agia Olga- Konstantopoulion, Athens, Greece. timkak@mail.gr
authors.forename: T N
authors.initials: TN
authors.lastname: Kakavoulis
authors.forename: C C
authors.initials: CC
authors.lastname: Avgoustou
authors.forename: H G
authors.initials: HG
authors.lastname: Koniaris
authors.forename: P C
authors.initials: PC
authors.lastname: Penlidis
mesh_terms: D000714:Anastomosis, Surgical; D004946:Esophagostomy; D005260:Female; D006551:Hernia, Hiatal / Q000150:complications / Q000601:surgery; D006801:Humans; D007582:Jejunostomy; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*