title: Combination of a free jejunal flap and a Roux-en-Y colojejunostomy for reconstruction of esophageal stricture secondary to a distant blast injury: a case report.
abstract: Pneumatic perforation of the esophagus caused by blast injury is very rare. Our patient presented with esophageal stricture in the context of a previous reconstruction of an esophageal rupture secondary to a distant air-blast injury. The ruptured esophagus was initially reconstructed with a left pedicled colon interposition in an antiperistaltic pattern. However, dysphagia developed 4 years later because of severe reflux-induced stenosis at the junction of the cervical esophagus and the left pedicled colon segment. A free isoperistaltic jejunal flap was performed to replace the cervical esophagus, with an anti-reflux Roux-en-Y colojejunostomy between the caudal segment of the left pedicled colon and the jejunum. The patient was discharged uneventfully 29 days later with smooth esophageal transit and no further reflux, as shown by scintigraphic scan. Esophageal reconstruction in an isoperistaltic pattern using a free isoperistaltic jejunal flap combined with an anti-reflux Roux-en-Y colojejunostomy has never been reported in the literature and appears to be an effective method to provide smooth passage of food and prevent restenosis of the esophagus.
authors.affiliation: Department of Surgery, Kaohsiung Medical University Hospital Kaohsiung, Taiwan, Republic of China.
authors.forename: Yi-Chia
authors.initials: YC
authors.lastname: Wu
authors.forename: Yueh-Bih
authors.initials: YB
authors.lastname: Tang
authors.forename: Wency
authors.initials: W
authors.lastname: Chen
authors.forename: Chung-Sheng
authors.initials: CS
authors.lastname: Lai
authors.forename: Hung-Chi
authors.initials: HC
authors.lastname: Chen
mesh_terms: D000328:Adult; D000713:Anastomosis, Roux-en-Y; D001753:Blast Injuries / Q000150:complications*; D003106:Colon / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects; D004940:Esophageal Stenosis / Q000209:etiology / Q000601:surgery*; D004947:Esophagus / Q000293:injuries*; D005260:Female; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D012086:Reoperation; D012421:Rupture / Q000209:etiology / Q000601:surgery; D013524:Surgical Flaps