Gastric Transposition for Severe Refractory Esophageal Stenosis After Corrosive Esophagitis Induced by Alkaline Detergent

Abstract

We herein report the case of a patient in which gastric transposition was effective for refractory esophageal stenosis induced by the accidental ingestion of a strong alkali. A 6-year-old girl had a history of esophageal stenosis due to corrosive esophagitis caused by the accidental swallowing of a strong alkali at 3 years of age. The patient was treated by balloon dilatation and radial incision and cutting (RIC). However, her esophageal stenosis relapsed; thus, gastric transposition was planned. The esophagus was removed by a thoracoscopic approach. The posterior mediastinal tunnel was formed by blunt dissection from cervical and abdominal incisions, and the cervical esophagus and stomach were anastomosed in the neck. After the gastric transposition, she was able to take food orally. Regular endoscopic examination was performed for the observation of anastomosis, and dilation was performed for mild anastomotic stenosis. Her physical growth was within the normal range, and no retardation was recognized after the reconstruction procedure. Corrosive esophagitis is chemical esophagitis induced by a corrosive agent swallowed such as a strong acid or alkali. Scarring esophageal stenosis is a late complication of corrosive esophagitis. Balloon dilatation is the first choice for the treatment of esophageal stenosis, but conservative treatment sometimes has limited efficacy. Surgical esophageal reconstruction should be considered for uncontrollable cases. Gastric transposition is considered a physiological and safe procedure for the treatment of severe esophageal stenosis.