Free Jejunum Flap for Secondary Corrosive Injury Reconstruction-A Case Report

Ingestion of corrosive substances can lead to severe injuries to the gastrointestinal tract and can even result in death. The degree and extent of damage depends on the type of substance, the quantity and the intention. In the acute stage, perforation and necrosis may occur. Long-term complications include stricture formation in the esophagus, antral necrosis, and development of esophageal carcinoma. It is a challenge for surgeons to perform esophageal reconstruction for these patients. Candidates for reconstruction to replace the esophagus include the stomach, jejunum, ileo-colon or colon, and skin flaps. The choices of substitutes were influenced by severity of the injury and the organs involved. When corrosive injury occurs, the stomach is frequently injured. Here we report a case in which the patient received reconstructions of the esophagus more than once due to a second intake of corrosive substances. The patient received an ileo-colon flap interposition for esophageal reconstruction after her first intake of an acidic solution. Her life quality was acceptable afterwards until she suffered from another episode of mental breakdown sixteen years later. The remnant ileo-left colon graft was used combined with microvascular supercharge for the second time reconstruction of the esophagus. Complications such as anastomosis leakage and stricture of neo-neoesophagus were noted, however. Reconstruction with a free jejunum flap was performed after resecting the narrowed part of the neo-neoesophagus. Post-operative outcome was satisfactory and no dysphagia was noted after one year follow-up.