Barrett's oesophagus and perforation of gastric tube ulceration into the pericardium: a late complication after reconstruction of oesophageal atresia.

15 years after replacement of atretic segment with a gastric tube, perforation of an intrathoracic gastric tube ulcer into the pericardium, oesophago-pericardial fistula and severe mediastinitis developed in a 17-year-old male after reconstruction of oesophageal atresia using a retrosternal Heimlich-tube with a cervical oesophagogastric anastomosis. For six years he suffered from reflux oesophagitis and had Barrett's metaplasia in the cervical oesophagus. The patient had previously had one unsuccessful attempt to correct the oesophageal atresia at the age of two years using transverse colon. The two stage treatment included subtotal oesophagectomy, pericardiotomy, cervical oesophagostomy, gastrostomy, mediastinal and pericardial irrigation with antibiotics. After healing of the mediastinitis, the continuity of the alimentary tract was restored by using an isoperistaltic subcutaneous ileocolic segment. After a follow-up of five years the patient is well, without any oesophageal symptoms.