Corrosive Injuries to Esophagus Following Double Suicide Attempts: Use of a Combined Free and Pedicled Jejunum Flap in Esophageal Reconstruction

Abstract

Background:Pedicled colon flap had been first choice in cases of whole esophagus reconstruction. A patient had received pedicled colon flap reconstruction for previous corrosive injury and attempted suicide for second time by swallowing corrosive fluid. In this situation, previously used colon segment had been destroyed, thus making reconstruction more difficult.Aim and Objectives:This case report describes the technical aspects of using staged combined free jejunum flap and pedicled jejunum flap in total esophageal reconstruction.Materials and Methods:Firstly, a free jejunal flap was used to reconstruct the cervical and upper thoracic portion of the esophagus. The proximal end was anastomosed but the distal end was left open on the chest wall. One month later, when the free jejunum flap was stable and the proximal anastomosis site was secured, a pedicled jejunal flap was haervested to reconstruct of the lower esophagus.Result:The esophagus was successfully reconstructed and the patient was able to take food orally without feeding from jejunostomy.Conclusion:Esophageal reconstruction using a combination of free and pedicled jejunum flap can be successfully achieved in patients whose colon or stomach is not available to be pedicled flaps for reconstruction.