Development of Esophageal Cancer from a Short Residual Esophagus 20 Years Following Corrosive Injury-Case Report and Treatment

Abstract

Background: The chance of developing carcinoma after corrosive injury is well known. Of all the patients with esophageal carcinoma, 1-4% patients have a history of caustic ingestion. 1~3 Nearly all the reported cases in the literature occurred after ingestion of lye, but did not undergo surgical treatment in the beginning. Aim and Objectives: A 54-year-old male patient suffered from corrosive injury 20 years ago. He received operation at that time with colon interposition following nearly total esophagectomy. A stricture was found 20 years later, and biopsy from the small residual esophageal segment showed esophageal carcinoma. The residual esophagus was removed and the defect was reconstructed with free radial forearm flap. However, recurrence was found 8 months later during endoscopic examination. A difficult reconstruction for the long esophageal defect was done after tumor resection. Materials and Methods: The patient suffered from tumor recurrence in the lower neck just at the junction between the skin flap and interposition colon. This time, complete esophagectomy including the interposition colon segment and forearm flap was successful. A long esophageal defect of about 40cm from pharynx to abdomen was presented. A difficult reconstruction with tubal anterolateral thigh and tensor fascia lata fasciocutaneous free flap was done to connect the pharyx to the abdomen. Results: The patient recovered well and was able to digest well post-operatively. Esophagogram showed smooth intake without leakage 3 months later. Conclusion: We conclude that corrosive esophageal carcinoma should be suspected in patients with previous corrosive injury if there is any change in their symptoms. Early surgical intervention with the diseased esophagus can lower the rate of malignancy formation. With the improvement of the reconstruction methods, extensive resection still can be done.