Stenosis due to late thrombosis in free jejunal graft

• Published in: JOURNAL OF JAPAN SOCIETY FOR HEAD AND NECK SURGERY Vol. 4; no. 2; pp. 129 - 131
• Main Author: Takagi, Tadashi
• Format: Journal Article
• Language: English
• Published: JAPAN SOCIETY FOR HEAD AND NECK SURGERY 1994
• Subjects: late thrombosis; microvascular surgery; stenosis of jejunal graft
• ISSN: 1349-581X; 1884-474X
• DOI: 10.5106/jjshns.4.129

Immediate jejunal autograft was proposed for reconstruction of the defect of the hypopharynx and cervical esophagus in 1959. Since then various free grafts of viscera, including the colon, gastric antrum, and sigmoid colon, have been employed to restore digestive continuity after pharyngolaryngoesophagectomy. The recent advancement of microvascular surgery has provided alternatives for reconstructing of defects. Jejunal free graft with microvascular reanastmosis is now accepted as one of the most reliable methods of restoring digestive continuity. Although the blood flow through vascular anastmosis during early stage after operation has a great influence on graft survival, there has been few report concerned with the occlusion in the late stage. The patient, a 64-year-old female, underwent pharyngolaryngoesophagectomy and bilateral neck dissection with one-stage reconstruction of the pharyngoesophageal defect a using free jejunal graft. Although a small fistula occurred at the esophageal anastmosis, it closed spontaneously in 2 weeks. The patient started to swallow and developed to have gruel at 5 weeks after the operation. However she complained of dysphagia at 2 months postperatively. A barium swallow study of digestive tract revealed a stenosis of jejunal graft. The complete occlusion of jejunal artery was detected by angiography. Clinical course of dysphagia, fluoroscopic examination, and angiography indicated that late thrombosis of jejunal artery led to partial necrosis of submucous layer followd by the stricture of transplanted jejunum caused by the scar formation.