title: Gastric conduit obstruction due to gastroduodenal compression: a new complication post-Ivor-Lewis oesophagectomy.
abstract: BACKGROUND
  Oesophagectomy for oesophageal carcinoma carries a high risk of significant morbidity and mortality. Delayed gastric emptying is a relatively common complication following this procedure. A variety of medical, surgical and endoscopic strategies have been described to manage it. The vast majority of cases are related to post-operative pyloric dysfunction and are amenable to conventional management strategies.
  
  
  METHODS
  We present a new case of a patient with a duodenal hiatus hernia resulting in extrinsic gastroduodenal compression by the massively distended gastric conduit as a cause of gastric outlet obstruction following laparoscopic-assisted Ivor-Lewis oesophagectomy 2 years previously.
  
  
  CONCLUSIONS
  Surgical repair of the hiatus hernia restored the post-oesophagectomy anatomy and resolved this patient's symptoms where conventional management of post-oesophagectomy gastric outlet obstruction had failed on multiple occasions. Most cases of delayed gastric emptying post-oesophagectomy occur as a result of pyloric dysfunction and can be managed using a combination of prokinetics, surgical intervention or more commonly, endoscopic dilatation. Other potential causes and therefore investigative and management strategies should be considered in patients who repeatedly fail conventional management. We offer an alternative diagnosis that may be considered in these patients and present a novel approach to their investigation and management.
authors.affiliation: a Department of Upper Gastrointestinal Surgery , Broomfield Hospital, Mid-Essex Hospital Trust , Essex , UK.
authors.forename: Victoria A
authors.identifier: http://orcid.org/0000-0002-4567-0898
authors.initials: VA
authors.lastname: Perkins
authors.affiliation: a Department of Upper Gastrointestinal Surgery , Broomfield Hospital, Mid-Essex Hospital Trust , Essex , UK.
authors.forename: Samuel
authors.initials: S
authors.lastname: McFerran
authors.affiliation: a Department of Upper Gastrointestinal Surgery , Broomfield Hospital, Mid-Essex Hospital Trust , Essex , UK.
authors.forename: Ali
authors.initials: A
authors.lastname: Kordzadeh
authors.affiliation: a Department of Upper Gastrointestinal Surgery , Broomfield Hospital, Mid-Essex Hospital Trust , Essex , UK.
authors.forename: Elias
authors.initials: E
authors.lastname: Sdralis
authors.affiliation: a Department of Upper Gastrointestinal Surgery , Broomfield Hospital, Mid-Essex Hospital Trust , Essex , UK.
authors.forename: Bruno
authors.initials: B
authors.lastname: Lorenzi
authors.affiliation: a Department of Upper Gastrointestinal Surgery , Broomfield Hospital, Mid-Essex Hospital Trust , Essex , UK.
authors.forename: Alexandros
authors.initials: A
authors.lastname: Charalabopoulos
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D004636:Emergency Service, Hospital; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects* / Q000379:methods; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000009:adverse effects* / Q000379:methods; D017219:Gastric Outlet Obstruction / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D008297:Male; D012086:Reoperation / Q000379:methods; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Gastric conduit obstruction; duodenal hiatus hernia; extrinsic duodenal compression; oesophagectomy; oesophagectomy complications