Braghetto Italo, Figueroa Manuel, Sanhueza Belén, Lanzarini Enrique, Sepulveda Sergio, Erazo Christian
Gastrointestinal.
Microsurgery Unit, Department of Surgery, University Hospital Dr José J. Aguirre, Faculty of Medicine, University of Chile, Santiago, Chile.
Arq Bras Cir Dig. 2018;31(2):e1381. doi: 10.1590/0102-672020180001e1381. Epub 2018 Jul 2.
Complete esophago-gastric necrosis after caustic ingestion is a challenging surgical scenario for reconstruction of the upper digestive transit.
To present a surgical technique for reconstruction of the upper digestive tract after total esophagectomy and gastrectomy due to esophageal and gastric necrosis.
The transit was re-established by means of a pharyngo-ileo-colic interposition with microsurgical arterial and venous anastomosis for augmentation of blood supply. Colo-duodeno-anastomosis and ileo-transverse colic anastomosis were performed for complete digestive transit reconstruction.
This procedure was applied in a case of 41 years male attempted suicide by ingesting alkali caustic liquid (concentrated sodium hydroxide). Total necrosis of the esophagus and stomach occurred, which required initially total esophago-gastrectomy, closure at the level of the crico-pharyngeal sphincter and jejunostomy for enteral feeding with a highly deteriorated quality of life . The procedure was performed later and there were no major early and late postoperative complications and normal nutritional conditions were re-stablished.
The procedure is feasible and must be managed by multidisciplinary team in order to re-establish a normal quality of life.
腐蚀性物质摄入后发生全食管胃坏死是上消化道重建手术中颇具挑战性的情况。
介绍一种因食管和胃坏死行全食管切除和胃切除术后上消化道重建的手术技术。
通过咽-回肠-结肠间置术重建消化道，并进行显微外科动静脉吻合以增加血供。行结肠-十二指肠吻合术和回肠-横结肠吻合术以完成消化道重建。
该手术应用于一名41岁男性，其因吞服碱性腐蚀性液体（浓氢氧化钠）企图自杀。食管和胃发生全坏死，最初需要行全食管胃切除术，在环咽括约肌水平关闭，并进行空肠造口术以进行肠内营养，患者生活质量严重下降。随后进行了该手术，术后无重大早期和晚期并发症，恢复了正常营养状况。
该手术可行，必须由多学科团队管理，以恢复正常生活质量。
