Adenocarcinoma on Colon Interposition for Corrosive Esophageal Injury: Case Report and Review of Literature

A 66-year-old man, without familial or personal previous history of colorectal polyp or cancer, was hospitalized for dysphagia and extreme weakness. Nineteen years ago, he underwent a right colon interposition for esophageal reconstruction after esophagectomy for caustic ingestion. Restoration of intestinal continuity was performed by terminoterminal coloduodenal anastomosis on the second part of the duodenum. In the postoperative course, a supra-anastomotic stenosis associated with an important biliary reflux was recorded. Repeated endoscopic dilatations were required for treatment of the stricture. The last dilatation was performed 2 years ago. The patient suffered from recurrent pneumonia due to the biliary reflux. In order to control this reflux, 10 months after the reconstruction, we performed a colostomy in the intra abdominal part of the colon interposition and the intestinal continuity was restored 5 months later. Symptoms associated with the reflux did not appear since restoration of intestinal continuity. An endoscopy was performed in front of this recent dysphagia and showed a 3-cm nonobstructive tumor in the colon interposition, few centimeters below the level of the ileocecal valve (Fig. 1), distant from the coloduodenal anastomosis. Biopsies and histological examination revealed an infiltrating poorly differentiated colon adenocarcinoma. Thoracic and abdominal CT scans showed numerous synchronous liver metastases (Fig. 2a) and mediastinal carcinomatosis surrounding the colon tumor (Fig. 2b, arrow). A palliative chemotherapy by FOLFOX was started but the patient died 3 months after the diagnosis from liver failure.