A “tuft” procedure

Abstract

A 53-year-old man presented with dysphagia for solid food. He had a history of esophageal atresia that had required repair with a colonic interposition as a child. In 2008, he had presented with dysphagia, dyspnea, and a bulge in his neck. Computed tomography (CT) scanning showed herniation of the colonic conduit into his neck with ischemic changes. He had undergone emergency resection of the conduit and esophagogastric reconstruction, which was complicated by a tight anastomotic stricture that had been managed with esophageal dilation and stenting for 3 years. Unfortunately, a large anterior esophagocutaneous fistula had developed in his chest wall, which required repair in 2012 with a pectoralis major musculocutaneous skin flap to reconstruct his cervical esophagus. He was subsequently referred for endoscopy because of recurrence of his dysphagia.