Pharyngo-laryngo-esophagectomy and reconstruction with a gastric tube for corrosive pharyngoesophagitis

Abstract

amount consumed [1]. Corrosive ingestion may lead to serious acute complications, such as esophageal or gastric perforation, respiratory insufficiency and death. Long-term complications include scarring and stricture formation [2]. Pharyngeal anastomosis is necessary in about 10 % of these patients [3].The scarred esophagus is traditionally either resected or bypassed using a colon conduit for the esophagus [1,4], because the stomach is usually also injured by the corrosive substance. However, using a gastric conduit has also been shown to have relatively good short-and long-term outcomes [5]. However, there have been few reports that have used a gastric conduit for esophageal replacement following pharyngo-laryngo-esophagectomy for such corrosive injuries. We herein report a rare case of gastric pull-up reconstruction following pharyngo-laryngo-esophagectomy during laparotomy after gastroduodenoscopy to treat a corrosive injury. Case reportA 44-year-old male accidentally ingested an unidentified liquid. He was admitted to a local emergency hospital. He was diagnosed to have corrosive pharyngo-esophagitis associated with gastritis due to the toxic chemical substances by upper gastrointestinal endoscopy. Conservative medical treatments were started in the intensive care unit. The patient developed gradually worsening dyspnea due to upper airway stenosis. A tracheotomy was therefore performed 15 days after the accident. Dysphagia also gradually progressed, and the patient was transferred to our hospital for the purpose of surgical intervention 91 days after the accident.The laryngeal fiberscope revealed severe deformity of the larynx and hypopharynx. Both sides of epiglottis and Abstract We herein present the case of a 44-year-old male who was successfully treated with pharyngo-laryngoesophagectomy for severe corrosive esophagitis associated with pharyngitis. He accidentally ingested an unidentified liquid and subsequently developed esophagitis and progressive pharyngolaryngitis. Since he also developed dyspnea, he initially underwent a tracheotomy at an emergency hospital. Afterward, dysphagia due to hypopharingoesophageal stricture gradually developed, and the patient was referred to our hospital. Therefore, under laparotomy, a feeding tube was inserted into the jejunostomy, and the gastroendoscope inserted via the anterior gastric wall revealed that the gastric mucosa along the greater curvature was intact. Based on this information, it was concluded that the patient could undergo reconstruction with a gastric tube following pharyngo-laryngo-esophagectomy, and this was successfully accomplished 3 months later.