Abstract
Esophago-gastric necrosis is a surgical emergency associated with high morbidity and mortality. We report a laparoscopic transhiatal esophago-gastrectomy performed on a 43-year-old male, presenting two hours after hydrochloric acid ingestion. A gastroscopy showed several oral mucosal ulcers, a significant edema of the pharynx and larynx, a necrosis of the middle and lower esophagus and of the gastric fundus and antrum. A conservative strategy with intensive care observation was initially followed. After a change of clinical signs, chest-abdominal computed tomography was realized and a pneumoperitoneum with free fluid in the left subphrenic space and bilateral pleural effusions was in evidence. A laparoscopic exploration was proposed to the patient, and confirmed the presence of free peritoneal fluid and necrosis with perforation of the upper part of the stomach. A laparoscopic total gastrectomy with subtotal esophagectomy was performed; the procedure finished with an esophagostomy on the left side of the neck and a laparoscopic feeding jejunostomy (video). Total operative time was 235 minutes. After six months a digestive reconstruction with esophagocoloplasty by laparotomy and cervicotomy was easily realized thanks to the advantages (few adhesions, bloodless, and simple colic mobilization) of the previous minimally invasive surgery.
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This paper received an award as one of the six best original contributions to the EAES video session at the 14th International EAES Congress in Berlin (Germany), 13–16 September 2006.
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Dapri, G., Himpens, J., Mouchart, A. et al. Laparoscopic transhiatal esophago-gastrectomy after corrosive injury. Surg Endosc 21, 2322–2325 (2007). https://doi.org/10.1007/s00464-007-9559-3
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DOI: https://doi.org/10.1007/s00464-007-9559-3