title: Late-onset dysphagia caused by severe spastic peristalsis of a free jejunal graft in a case of hypopharyngeal cancer.
abstract: Free jejunal transfer is the main technique used for reconstructing a circumferential defect caused by total pharyngo-laryngo-cervical-esophagectomy in certain cancer cases. We report a rare case of severe late-onset dysphagia caused by autonomous spastic peristalsis, which led to complete obstruction of the free jejunal route. A 70-year-old man underwent treatment for hypopharyngeal cancer involving total pharyngolaryngectomy with free jejunal transfer. After uneventful peri- and postoperative recovery, he developed sudden-onset severe dysphagia 22 months later. Gastrografin fluoroscopy revealed abnormal peristalsis and contraction of the transferred jejunum, leading to complete obstruction. Nutritional treatment, application of depressants of peristalsis, and xylocaine injection into the outer space of the jejunal mucosa all failed to alleviate the dysphagia. Surgical treatment involving a longitudinal incision of the jejunal graft, and interposing a cutaneous flap, as a fixed wall, between the incised jejunal margins to prevent obstruction was performed. After further reconstructive surgery involving using a pectoralis major musculocutaneous flap and a split-thickness skin graft to close a refractory jejunum-skin fistula, the dysphagia was permanently alleviated. To our knowledge, this is the first report of severe dysphagia caused by peristalsis of a free jejunal graft.
authors.affiliation: Department of Head and Neck Surgery, Miyagi Cancer Center, Natori, Miyagi, Japan. Electronic address: takayuki.imai629@gmail.com.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Imai
authors.affiliation: Department of Plastic Surgery, Miyagi Cancer Center, Natori, Miyagi, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Goto
authors.affiliation: Department of Diagnostic Radiology, Miyagi Cancer Center, Natori, Miyagi, Japan.
authors.forename: Ko
authors.initials: K
authors.lastname: Matsumoto
authors.affiliation: Department of Plastic Surgery, Miyagi Cancer Center, Natori, Miyagi, Japan.
authors.forename: Koreyuki
authors.initials: K
authors.lastname: Kurosawa
authors.affiliation: Department of Head and Neck Surgery, Miyagi Cancer Center, Natori, Miyagi, Japan.
authors.forename: Yukinori
authors.initials: Y
authors.lastname: Asada
authors.affiliation: Department of Head and Neck Surgery, Miyagi Cancer Center, Natori, Miyagi, Japan.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Saijo
authors.affiliation: Department of Head and Neck Surgery, Miyagi Cancer Center, Natori, Miyagi, Japan.
authors.forename: Kazuto
authors.initials: K
authors.lastname: Matsuura
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D003680:Deglutition Disorders / Q000601:surgery*; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000601:surgery*; D007412:Intestinal Fistula / Q000601:surgery*; D007583:Jejunum / Q000637:transplantation*; D007825:Laryngectomy; D008297:Male; D009128:Muscle Spasticity; D064827:Myocutaneous Flap; D010528:Peristalsis; D010611:Pharyngectomy; D011183:Postoperative Complications / Q000601:surgery*; D019651:Plastic Surgery Procedures; D013035:Spasm / Q000601:surgery*; D000077195:Squamous Cell Carcinoma of Head and Neck; D013524:Surgical Flaps
keywords: Dysphagia; Fistula; Free jejunal graft; Peristalsis; Pharyngo-laryngo-cervical-esophagectomy