Esophageal Stricture Associated with Stevens-Johnson Syndrome-Reconstruction with Free Jejunum Interposition-

Abstract

Stevens-Johnson syndrome is characterized by acute onset, high fever and extensive involvements of the skin, mucosa and eyes. Although mucosal lesion is frequently seen in oropharyngeal, ocular, anal and urogenital area, esophageal lesion is rare. Only 11 cases have been reported in the literature.A 65 year-old male was diagnosed as Stevens-Johnson syndrome by sudden onset of erythematous eruption and mucosal involvements of oral and ocular areas. He could not swallow liquids or foods at all during more than 1 year after the onset because of progressive dysphagia and frequent aspiration pneumonia due to cervical esophageal stricture detected by a barium swallow and endoscopy. Attempts to pass catheters into the esophagus were unsuccessful. A free jejunal graft was interposed between the left pyriform sinus and intact cervical esophagus preserving the larynx. Postoperative course was uneventful and the patient started to swallow on the 16th postoperative day and developed to take a regular diet at 2 months after the operation.The pathologic involvements of the esophagus with Stevens-Johnson syndrome were bibriographically reported only in 11 patients. Initial descriptions of esophageal lesion were postmortem findings. Stein et al. first reported the esophageal stricture located in the distal esophagus. Conservative therapy with subsequent dilatations and antiacids allowed the patient to take a regular diet. The successful reports of dilatations for esophageal stricture were followed by Peter et al. and Howell et al. The case presented here is the first patient treated surgically with free jejunum interposition for esophageal stricture associated with Stevens-Johnson syndrome.