Corrosive Esophagitis and Gastritis Secondary to Alkali Ingestion Treated with Video-Assisted Thoracoscopic Esophagectomy and Laparoscopic Total Gastrectomy Followed by Second-Stage Reconstruction

Abstract

A 60-year-old man ingested an alkaline detergent in a suicide attempt. He was taken to a local hospital, and upper gastrointestinal endoscopy revealed corrosive changes from the pharynx to the pyloric region of the stomach. Despite conservative therapy, prolonged hematemesis occurred. He was transferred to our hospital for surgery, and we performed video-assisted thoracoscopic esophagectomy and laparoscopic total gastrectomy 30 days after ingestion. Considering the risk of delayed stenosis, we planned second-stage reconstruction with a 4-month observation period. Delayed stenosis of the esophageal orifice was confirmed during preoperative upper gastrointestinal endoscopy, but we were able to preserve laryngeal function. We performed residual esophageal resection and reconstruction with a free jejunal autograft through an antesternal approach 121 days after the primary surgery. Although the time to resume oral intake was prolonged because of laryngopharyngeal edema and healing of the anastomotic site, the patient was discharged 78 days after second-stage reconstruction surgery. Because corrosive esophagitis and gastritis caused by alkaline agents can cause delayed stenosis, second-stage reconstruction could be a useful surgical strategy. In addition, video-assisted surgery may be a good choice as an early surgical approach for corrosive esophagitis and gastritis before the inflammation has progressed.