Late-onset Colonic Graft and Overlying Skin Necrosis 15 Years After Esophagectomy and Gastrectomy: A Case Report.

Abstract

Background/aim: Colonic interposition following esophagectomy for esophageal cancer is a relatively uncommon reconstructive procedure, primarily indicated in patients who have undergone or require gastrectomy. Graft loss predominantly results from compromised perfusion due to feeding vessel insufficiency, generally occurring within weeks after surgery. We present the first case of delayed necrosis of colonic graft and skin occurring 15 years after subtotal esophagectomy and total gastrectomy.

Case report: A 67-year-old female patient had a history of subtotal esophagectomy and total gastrectomy 15 years ago for early-stage esophageal and gastric cancer. She presented with acute chest wall swelling and constipation. Contrast-enhanced computed tomography demonstrated marked distension of the colonic graft and poor contrast in the colonic graft wall under the necrotic skin. The patient underwent a two-stage surgical intervention, using a left colonic graft for reconstruction. After being discharged 83 days after her initial admission, the patient remained asymptomatic six months later.

Conclusion: This report presents a case of delayed necrosis of a colonic graft that occurred 15 years after the primary surgery, which was successfully treated through drainage surgery and two-stage reconstruction using a left colonic graft. It should be kept in mind that colonic graft necrosis, a rare late complication of esophagectomy, can progress rapidly.