Resting energy expenditure (REE) was studied in five patients undergoing transhiatal and in 14 undergoing transthoracic oesophagectomy for carcinoma. All resections were performed with an intention to cure. REE was measured by indirect calorimetry before operation and on days 1, 3, 5 and 7 after surgery. Following transthoracic oesophagectomy, REE increased significantly on days 1, 3, 5 and 7 after operation, and on day 7 the value was significantly higher (P < 0.05) than that obtained after transhiatal surgery. Energy expenditure following transhiatal oesophagectomy is lower than that after transthoracic oesophagectomy; this may be a result of reduced surgical stress.

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We report a case of esophageal perforation caused by an explosion, but which was not diagnosed until 3 days after the injury. A 53-year-old worker sustained superficial dermal burns to his trachea, face, neck, and legs during an explosion. The burns were treated conservatively at a local hospital, but he was transferred to our hospital 3 days after the injury, when mediastinal emphysema and bilateral pleural effusion became evident. An esophagogram followed by computed tomography showed an esophageal perforation caused by the blast injury, and we performed an esophagectomy with recontruction of the gastric tube. After the operation, an X-ray showed a foreign body in the lower abdomen, which we found in the upper thoracic esophagus on the day of injury. We surmised that the patient had inadvertently swallowed a foreign body, which had been heated and scattered by the explosion, and it had melted the upper thoracic esophagus.

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A 47-year-old man suffering from abdominal pain and vomiting had been admitted a third time for the same symptoms, but previously treated conservatively. Based on abdominal computed tomography and hypotonic duodenography, we diagnosed obstruction of the jejunum due to an internal hernia in the Treitz ligament and conducted a laparotomy. We found that the jejunum, 6cm distal to the Treitz ligament adhered to the retroperitonium, forming a diverticulum. We conducted wedge resection and the postoperative course was uneventful. Histopathological examination of the diverticulum showed a true diverticulum of the jejunum with an inflammatory change at the serosa but not at the mucosa site. The definitive diagnosis was traction jejunal diverticulosis, making this case one of interest due to its rarity.