A Case of Intestinal Obstruction After Esophageal Cancer Surgery Caused by Incarceration in to the Gap between the Jejunostomy Site and the Abdominal Wall

Abstract

A man in his 70s had an esophagectomy for esophageal cancer with reconstruction using a gastric tube by the posterior mediastinal route. At the same time, he received a jejunostomy for enteral alimentation. Although there was no recurrence of the esophageal cancer, he had repeated intestinal obstruction that was relieved with conservative treatment. Six years after the esophageal cancer surgery, he complained of abdominal pain and vomiting. he was admitted under a diagnosis of intestinal obstruction. His abdomen was slightly bulging and tenderness was noted, but there was no apparent peritoneal irritation symptom. On abdominal contrast CT imaging, a spiral-like finding was found in the mesentery of the small intestine, and the superior mesenteric artery (SMA) was deviated to the left. An emergency operation was performed on suspicion of intestinal obstruction caused by the jejunostomy. Upon laparotomy, the small intestine was incarcerated into the gap between the jejunostomy site and the abdominal wall, and rotated counterclockwise. Intestinal resection was not performed because no necrosis was observed. The jejunum of the intestinal fistula formation site was peeled from the abdominal wall. Intestinal obstruction involving the jejunostomy site after esophageal surgery is one of the conditions encountered in clinical practice although it rarely occurs. We report on this condition with a review of the relevant literature.