Esophageal caustic stenosis – difficulties of therapeutic management

Abstract

Esophageal stenosis is one of the most common sequels of caustic injury. After the ingestion, in the acute phase, the life support is sometimes critical, and the treatment varies from observation to esophagectomy. During the first 6 months, endoscopic dilation can be necessary in order to maintain the patency of the esophageal lumen.
 Usually, endoscopic dilation is the treatment of choice for caustic stenosis of the esophagus. Sometimes this procedure is not possible or too risky and then reconstruction surgery is needed, but no earlier than 6 months.
 We present the case of a 57 years old male who was referred to our clinic for the treatment of a mid-esophageal caustic stenosis, after the accidental ingestion of a concentrated alkaline substance 6 months before. After an initial successful endoscopic dilation, in the second attempt, due to the asymmetric position of the stenosis and the high risk of perforation, we decided to perform an esophageal by-pass. We chose to use the left colon for interposition, with the left branch of middle colic artery as the feeding source and the sigmoid trunk as the second arcade. The surgical procedure went uneventful, with restoration of normal oral feeding.