Late-onset dysphagia caused by severe spastic peristalsis of a free jejunal graft in a case of hypopharyngeal cancer

Takayuki Imai, Takahiro Goto, Ko Matsumoto, Koreyuki Kurosawa, Yukinori Asada, Shigeru Saijo, Kazuto Matsuura

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)

Abstract

Free jejunal transfer is the main technique used for reconstructing a circumferential defect caused by total pharyngo-laryngo-cervical-esophagectomy in certain cancer cases. We report a rare case of severe late-onset dysphagia caused by autonomous spastic peristalsis, which led to complete obstruction of the free jejunal route. A 70-year-old man underwent treatment for hypopharyngeal cancer involving total pharyngolaryngectomy with free jejunal transfer. After uneventful peri- and postoperative recovery, he developed sudden-onset severe dysphagia 22 months later. Gastrografin fluoroscopy revealed abnormal peristalsis and contraction of the transferred jejunum, leading to complete obstruction. Nutritional treatment, application of depressants of peristalsis, and xylocaine injection into the outer space of the jejunal mucosa all failed to alleviate the dysphagia. Surgical treatment involving a longitudinal incision of the jejunal graft, and interposing a cutaneous flap, as a fixed wall, between the incised jejunal margins to prevent obstruction was performed. After further reconstructive surgery involving using a pectoralis major musculocutaneous flap and a split-thickness skin graft to close a refractory jejunum-skin fistula, the dysphagia was permanently alleviated. To our knowledge, this is the first report of severe dysphagia caused by peristalsis of a free jejunal graft.

Original languageEnglish
Pages (from-to)693-697
Number of pages5
JournalAuris Nasus Larynx
Volume43
Issue number6
DOIs
Publication statusPublished - 2016 Dec 1
Externally publishedYes

Keywords

  • Dysphagia
  • Fistula
  • Free jejunal graft
  • Peristalsis
  • Pharyngo-laryngo-cervical-esophagectomy

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology

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