First experience with a supercharged pedicled jejunal interposition for esophageal replacement after caustic ingestion in a middle-income Latin American country

Abstract

Caustic or corrosive substance ingestion that results in severe esophageal and gastric lacerations frequently requires surgical management. The most common sequelae after an upper gastrointestinal tract caustic injury include non-responding luminal strictures, which are subject to esophageal replacement. Late corrective surgery may include esophagectomy with gastric pull-up and jejunal or colonic interpositions. Although long-segment esophageal reconstruction with jejunum is technically feasible and has demonstrated good outcomes, the complexity of the surgery has precluded the widespread use of this procedure in low- and middle-income countries.

This document summarizes the most relevant aspects of caustic ingestion surgical management and describes the first Latin American experience in the reconstruction of an esophageal-gastric caustic injury using a pedicled jejunal interposition, as a viable and functional option in mid- and lower-income countries with well-established Thoracic Surgery departments and microsurgery access.

Graphical abstract

Highlights

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  Caustic or corrosive ingestion that results in severe esophageal and gastric lacerations, often require surgical management.

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  Caustic injuries can cause small ulcerations to full-thickness lesions with necrosis and perforation of the digestive tube.

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  Late correction surgery is reserved for severe cases were other alternatives fail or are not appropriate.

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  Case report of the first experience in a middle-income country in Latin America.