Fujimoto Keisuke, Inoue Seiya, Goto Masakazu, Sakamoto Shinichi, Misaki Mariko, Fujiwara Satoshi, Yoshida Takahiro, Toba Hiroaki, Takizawa Hiromitsu
Department of Thoracic, Endocrine Surgery, and Oncology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Tokushima, Japan.
Surg Case Rep. 2025;11(1). doi: 10.70352/scrj.cr.24-0116. Epub 2025 Mar 11.
Corrosive esophagitis, often caused by the ingestion of alkalis, acids, or heavy metals, can result in severe esophageal damage and complications, such as stenosis or closure. Although initial treatment is conservative, surgical intervention is necessary when a chronic stricture occurs. A case of esophageal atresia persisting for 50 years due to corrosive esophagitis has not yet been reported. Here, we describe such a case.
The patient was a 72-year-old woman. At 20 years of age, she ingested an alkali substance in a suicide attempt, leading to the development of corrosive esophagitis. Surgery was initially considered for esophageal atresia but was deemed unfeasible at the time; therefore, gastrostomy was performed instead. Subsequently, for over 50 years, she manually chewed food and inserted it into her gastric tube. She was urgently transported to a nearby hospital after her general condition deteriorated due to an influenza infection. During hospitalization, her nutritional intake was reassessed, and given her strong desire for oral intake, she was referred to our hospital for surgical treatment. Her gastric mucosa was intact, and imaging revealed mild mediastinal inflammation and fibrosis, rendering esophageal resection and reconstruction feasible. Considering surgical invasiveness, we opted for a mediastinoscopic esophagectomy and performed posterior mediastinal reconstruction using a gastric tube with a cervical hand-sewn anastomosis. The patient recovered without any complications and was discharged. Although postoperative aspiration and swallowing disorders were anticipated, the patient experienced none, likely because her unique self-feeding method preserved the functions of her masticatory and swallowing muscles.
We report an extremely rare case of a patient with a unique history of esophageal atresia following corrosive esophagitis for over 50 years who successfully underwent minimally invasive esophagectomy using mediastinoscopy and had a favorable outcome. Mediastinoscopic esophagectomy is a minimally invasive option for such patients.
腐蚀性食管炎通常由摄入碱、酸或重金属引起，可导致严重的食管损伤及并发症，如狭窄或闭锁。尽管初始治疗是保守的，但当发生慢性狭窄时手术干预是必要的。因腐蚀性食管炎导致食管闭锁持续50年的病例尚未见报道。在此，我们描述这样一例病例。
患者为一名72岁女性。20岁时，她为自杀而摄入碱性物质，导致腐蚀性食管炎。最初考虑对食管闭锁进行手术，但当时认为不可行；因此，改为行胃造瘘术。随后，50多年来，她一直手动咀嚼食物并将其插入胃管。因流感感染导致全身状况恶化后，她被紧急送往附近医院。住院期间，对她的营养摄入进行了重新评估，鉴于她强烈的经口进食愿望，她被转诊至我院接受手术治疗。她的胃黏膜完好无损，影像学检查显示有轻度纵隔炎症和纤维化，使食管切除重建可行。考虑到手术创伤，我们选择了纵隔镜下食管切除术，并使用胃管进行后纵隔重建，采用颈部手工缝合吻合。患者康复过程中无任何并发症，已出院。尽管预计术后会出现误吸和吞咽障碍，但患者并未出现，可能是因为她独特的自我进食方式保留了咀嚼和吞咽肌肉的功能。
我们报告了一例极为罕见的病例，该患者有超过50年腐蚀性食管炎后食管闭锁的独特病史，成功接受了纵隔镜下微创食管切除术，且预后良好。纵隔镜下食管切除术是这类患者的一种微创选择。
