Roux-en-Y Gastrojejunostomy to a Gastric Pull-Up Transhiatal Esophagectomy for a Concurrent Esophageal and Duodenal Pept
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CASE REPORT
Roux-en-Y Gastrojejunostomy to a Gastric Pull-Up Transhiatal Esophagectomy for a Concurrent Esophageal and Duodenal Peptic Stricture—a Rare Case Gurushantappa Yalagachin 1 & Nishanth Lakshmikantha 2
&
Sanjay B. Mashal 1
Received: 1 July 2020 / Accepted: 18 September 2020 # Association of Surgeons of India 2020
Abstract Esophageal strictures are usually benign with the most common cause being reflux from acid peptic disease. The concurrent strictures of the esophagus and duodenum are a rarity and such concurrent strictures secondary to acid peptic disease have not been reported in the literature so far. These strictures are managed endoscopically and the role of surgery is reserved for refractory strictures. Here, we present a case of concurrent esophageal and duodenal peptic strictures which was managed surgically by performing a transhiatal esophagectomy and a Roux-en-Y gastrojejunal anastomosis to the gastric tube. The patient recovered well and is currently on 2 years follow-up. Surgery for benign esophageal strictures is to be considered when endoscopic procedures cannot be performed or have failed. Concurrent duodenal and esophageal strictures are very rare. Gastric tube pull-up with Roux-en-Y bypass performed when there is an adequate intra-abdominal stomach tube is a safe and feasible option. Keywords Concurrent stricture . Peptic stricture . Roux-en-y gastrojejunostomy . Transhiatal esophagectomy . Dysphagia
Introduction Esophageal strictures are most commonly benign. The cause for these strictures may be inflammatory, neuromuscular, and iatrogenic with the most common cause being gastroesophageal reflux disease. The standard of care is conservative management with endoscopic methods such as serial dilatations [1]. Surgery is indicated for refractory strictures. Esophagectomy is the most commonly preferred surgery. Concurrent esophageal and duodenal strictures are rare and seen in corrosive injuries, Crohn’s disease and eosinophilic esophagitis. However,
* Nishanth Lakshmikantha [email protected] Gurushantappa Yalagachin [email protected] Sanjay B. Mashal [email protected] 1
Department of General Surgery, Karnataka Institute of Medical Sciences, Hubli 580022, India
2
Shanthi Hospital and Research Centre (SHRC), 307, 40th Cross, 8th Block, Jayanagar, Bangalore 560 070, India
there are no cases reported in the literature with such concurrent strictures secondary to acid peptic disease.
Case A 50-year-old male presented with aphagia since 3 days. He had undergone recurrent endoscopic bougie dilatation of the esophagus 12 times in 3 years with 1–2 months interval between every dilatation. Contrast-enhanced computed tomography (CECT) of the chest and abdomen showed asymmetric mucosal thickening in the distal esophagus for 2 cm and no infiltration into the major vessels, or lymphadenopathy. Previous endoscopic reports also noted antral gastritis for which he was treated. The patient was on treatment for schizophrenia. He had no history of alcohol, smoking, or chronic analge
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