Perforation of colonic interposition graft in a patient with prior esophagectomy: a case report

Carlos Israel Verdugo Salazar; Salvador Zadur Kaloyan Lopez; Casandra Rosas Rios; Yamir Ahmed Nacud Bezies; Luis Fernando Gálvez Coutiño

doi:10.18203/2349-2902.isj20251176

Authors

Carlos Israel Verdugo Salazar Unidad Medica de Alta Especialidad, del IMSS, Monterrey Nuevo León, Mexico
Salvador Zadur Kaloyan Lopez Unidad Medica de Alta Especialidad, del IMSS, Monterrey Nuevo León, Mexico
Casandra Rosas Rios Unidad Medica de Alta Especialidad, del IMSS, Monterrey Nuevo León, Mexico
Yamir Ahmed Nacud Bezies Unidad Medica de Alta Especialidad, del IMSS, Monterrey Nuevo León, Mexico
Luis Fernando Gálvez Coutiño Unidad Medica de Alta Especialidad, del IMSS, Monterrey Nuevo León, Mexico

DOI:

https://doi.org/10.18203/2349-2902.isj20251176

Keywords:

Colonic transposition, Esophageal replacement, Graft ischemia, Neoesophageal perforation, Diaphragmatic hernia

Abstract

Colonic interposition is an established technique for esophageal replacement when gastric pull-up is not feasible. While it provides functional long-term results in selected patients, complications such as ischemia, redundancy, and perforation may occur. We report the case of a 47-year-old male with a history of esophageal perforation and colonic transposition who presented nine years later with acute abdomen. Imaging revealed a complicated diaphragmatic hernia, and exploratory laparotomy showed ischemic and perforated neoesophagus. The patient required urgent resection of the colonic graft, esophagostomy, and negative pressure wound therapy for surgical site infection. Complications of colonic transposition may be early (ischemia, leakage) or late (stenosis, reflux, redundancy, and perforation). Graft ischemia remains a major contributor to postoperative morbidity. Adequate vascularization, careful anastomotic technique, and long-term monitoring are crucial for favorable outcomes. This case highlights a rare but severe late complication of colonic interposition, emphasizing the need for vigilance in long-term follow-up and timely surgical intervention.

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