title: Ileo-right hemi-colonic cervical pull-up on a non-supercharged ileocolic arterial pedicle: A technical and case report.
abstract: Esophageal reconstruction can be challenging when stomach and colon are not anatomically intact and their use as esophageal substitutes is therefore limited. Innovative individual approaches are then necessary to restore the intestinal passage. We describe a technique in which a short stump of the right hemicolon and 25 cm of ileum on a long, non-supercharged, fully mobilized ileocolic arterial pedicle were used for esophageal reconstruction to the neck. In this case, a 65 year-old male patient had accidentally indigested hydrochloric acid which caused necrosis of his upper digestive tract. An emergency esophagectomy, gastrectomy, duodenectomy, pancreatectomy and splenectomy had been performed in an outside hospital. A cervical esophagostomy and a biliodigestive anastomosis had been created and a jejunal catheter for enteral feeding had been placed. After the patient had recovered, a reconstruction of his food passage via the left and transverse colon failed for technical reasons due to an intraoperative necrotic demarcation of the colon. Our team then faced the situation that only a short stump of the right hemi-colon was left in situ when the patient was referred to our center. After intensified nutritional therapy, we reconstructed this patient's food passage with the right hemicolon-approach described herein. After treatment of a postoperative pneumonia, the patient was discharged from hospital on the 26(th) postoperative day in a good clinical condition on an oral-only diet. In conclusion, individual approaches for long-segment reconstruction of the esophagus can be technically feasible in experienced hands. They do not always require arterial supercharging or free intestinal transplantation.
authors.affiliation: Andreas RR Weiss, Christina Hackl, Yorick Soeder, Hans J Schlitt, Marc-H Dahlke, Department of Surgery, University Medical Center Regensburg, 93042 Regensburg, Germany.
authors.forename: Andreas Rr
authors.initials: AR
authors.lastname: Weiss
authors.affiliation: Andreas RR Weiss, Christina Hackl, Yorick Soeder, Hans J Schlitt, Marc-H Dahlke, Department of Surgery, University Medical Center Regensburg, 93042 Regensburg, Germany.
authors.forename: Christina
authors.initials: C
authors.lastname: Hackl
authors.affiliation: Andreas RR Weiss, Christina Hackl, Yorick Soeder, Hans J Schlitt, Marc-H Dahlke, Department of Surgery, University Medical Center Regensburg, 93042 Regensburg, Germany.
authors.forename: Yorick
authors.initials: Y
authors.lastname: Soeder
authors.affiliation: Andreas RR Weiss, Christina Hackl, Yorick Soeder, Hans J Schlitt, Marc-H Dahlke, Department of Surgery, University Medical Center Regensburg, 93042 Regensburg, Germany.
authors.forename: Hans J
authors.initials: HJ
authors.lastname: Schlitt
authors.affiliation: Andreas RR Weiss, Christina Hackl, Yorick Soeder, Hans J Schlitt, Marc-H Dahlke, Department of Surgery, University Medical Center Regensburg, 93042 Regensburg, Germany.
authors.forename: Marc-H
authors.initials: MH
authors.lastname: Dahlke
mesh_terms: D000368:Aged; D002057:Burns, Chemical / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D003106:Colon / Q000098:blood supply / Q000601:surgery*; D016629:Esophagectomy; D004947:Esophagus / Q000473:pathology / Q000601:surgery*; D005743:Gastrectomy; D006801:Humans; D006851:Hydrochloric Acid / Q000009:adverse effects*; D007082:Ileum / Q000098:blood supply / Q000601:surgery*; D008297:Male; D009752:Nutritional Status; D010180:Pancreatectomy; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D013156:Splenectomy; D016896:Treatment Outcome
chemical_list: D006851:Hydrochloric Acid
keywords: Colonic interposition; Esophageal cancer; Esophageal reconstruction; Esophageal trauma; Gastric pull-up