Laparoscopic transhiatal esophago-gastrectomy after corrosive injury.
Esophago-gastric necrosis is a surgical emergency associated with high morbidity and mortality. We report a laparoscopic transhiatal esophago-gastrectomy performed on a 43-year-old male, presenting two hours after hydrochloric acid ingestion. A gastroscopy showed several oral mucosal ulcers, a significant edema of the pharynx and larynx, a necrosis of the middle and lower esophagus and of the gastric fundus and antrum. A conservative strategy with intensive care observation was initially followed. After a change of clinical signs, chest-abdominal computed tomography was realized and a pneumoperitoneum with free fluid in the left subphrenic space and bilateral pleural effusions was in evidence. A laparoscopic exploration was proposed to the patient, and confirmed the presence of free peritoneal fluid and necrosis with perforation of the upper part of the stomach. A laparoscopic total gastrectomy with subtotal esophagectomy was performed; the procedure finished with an esophagostomy on the left side of the neck and a laparoscopic feeding jejunostomy (video). Total operative time was 235 minutes. After six months a digestive reconstruction with esophagocoloplasty by laparotomy and cervicotomy was easily realized thanks to the advantages (few adhesions, bloodless, and simple colic mobilization) of the previous minimally invasive surgery.
Dapri
G
G
Department of Gastrointestinal Surgery, European School of Laparoscopic Surgery, Saint-Pierre University Hospital, Brussels, Belgium.
Himpens
J
J
Mouchart
A
A
Ntounda
R
R
Claus
M
M
Dechamps
Ph
P
Hainaux
B
B
Kefif
R
R
Germay
O
O
Cadière
G B
GB
D000328:Adult; D002057:Burns, Chemical / Q000601:surgery*; D002424:Caustics / Q000633:toxicity; D004638:Emergency Treatment; D016629:Esophagectomy / Q000379:methods*; D004947:Esophagus / Q000293:injuries*; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D006851:Hydrochloric Acid / Q000633:toxicity*; D010535:Laparoscopy; D008297:Male; D013270:Stomach / Q000293:injuries*; D013406:Suicide, Attempted
D002424:Caustics; D006851:Hydrochloric Acid