Use of a free jejunal graft for oesophageal reconstruction following perforation after cervical spine surgery: case report and review of the literature.

Journal Article

STUDY DESIGN: : Single-subject (male, 16 years of age) case. OBJECTIVES: To demonstrate a suitable method for oesophageal repair after perforation as a complication of anterior spinal fusion in an individual with quadriplegia, and to review the literature on oesophageal perforation and repair. SETTING: University hospital, large trauma centre with departments for spinal injuries and reconstructive surgery in Germany. METHODS: A free jejunal graft used for oesophageal reconstruction in a post-traumatic situation after a complicated treatment course in a C6 quadriplegic patient. RESULTS: A protuberant loose screw of the titanium plate after anterior spinal fusion perforated the oesophagus. Imbricating sutures and a fascia lata patch were insufficient to repair the oesophageal leakage. An 8 cm long segment of the cervical oesophagus including a fistula had to be excised, and a free microsurgical jejunal flap was used for restitution of continuity. The jejunal vessels were connected to the superior thyroid artery and external jugular vein. At 1 week after the oesophageal repair, an enteral contrast study showed a small amount of contrast medium leaking at the oesophago-pharyngeal anastomosis. A percutaneous gastric tube was inserted, and oral feeding was limited to tea and still water for 4 weeks. The further course was uneventful. CONCLUSIONS: Oesophageal perforation is a rare but recognized complication after cervical spine surgery, which can mostly be managed using secondary suture techniques. The free jejunal flap is a reliable and innovative tool in the particularly complex situation of a segmental oesophageal loss. It should be considered in similar cases to reconstruct oesophageal continuity or to treat stricture and fistula formations.

Full Text

Duke Authors

Cited Authors

  • Küntscher, MV; Erdmann, D; Boltze, W-H; Germann, G

Published Date

  • October 1, 2003

Published In

Volume / Issue

  • 41 / 10

Start / End Page

  • 543 - 548

PubMed ID

  • 14504610

International Standard Serial Number (ISSN)

  • 1362-4393

Digital Object Identifier (DOI)

  • 10.1038/sj.sc.3101439

Language

  • eng

Conference Location

  • England