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 Table of Contents  
CASE REPORT
Year : 2018  |  Volume : 51  |  Issue : 6  |  Page : 238-240

Chemical colitis in posterior mediastinum colonic conduit


Department of Surgery, Show Chwan Memorial Hospital, Changhua, Taiwan

Date of Submission26-Apr-2018
Date of Decision11-May-2018
Date of Acceptance31-Jul-2018
Date of Web Publication11-Dec-2018

Correspondence Address:
Dr. Chia-Ying Li
Department of Surgery, Show Chwan Memorial Hospital, No. 542, Sec. 1, Chung-Shan Rd., Changhua 500
Taiwan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/fjs.fjs_43_18

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  Abstract 

For patients with severe corrosive injury of the esophagus and stomach, the colon is considered a well-functional and durable esophageal substitute. We report a Chinese male suffered from chemical colitis of the colon conduit located in the posterior mediastinum after drinking strong liquor. To the best of our knowledge, this is the first case reported in the literature. After conservative and supportive therapy with antibiotics and oral fasting, he recovered from chemical conduit colitis completely.

Keywords: Case report, chemical colitis, colon interposition, esophageal replacement


How to cite this article:
Mai CM, Li CY. Chemical colitis in posterior mediastinum colonic conduit. Formos J Surg 2018;51:238-40

How to cite this URL:
Mai CM, Li CY. Chemical colitis in posterior mediastinum colonic conduit. Formos J Surg [serial online] 2018 [cited 2019 Jun 26];51:238-40. Available from: http://www.e-fjs.org/text.asp?2018/51/6/238/247311


  Introduction Top


Colon interposition has been used for esophageal replacement for a long time.[1] We reported a case who received esophageal replacement by colon conduit 2 years ago because of corrosive esophageal stricture. After drinking alcohol, he suffered from chemical colitis of colon conduit located in the posterior mediastinum. By reviewing the literature, we thought that this is the first case being reported.


  Case Report Top


A 29-year-old Chinese male presented to the hospital complaining of fever, chest pain, and dysphagia for 3 days. Two years ago, he committed suicide by ingestion of caustic agent. One month after the episode, he suffered from dysphagia due to severe esophageal and pyloric stenosis. He received the operations of esophagectomy and total gastrectomy. Reconstruction by right colon conduit was performed at the same time. He had a smooth postoperative course and was under regular outpatient department follow-up. This time, he reported drinking 250–300 mL of Kaoliang which is strong distilled liquor every day for 3 consecutive days. After that, chest pain, odynophagia, and dysphagia occurred. Therefore, he was sent to the hospital. The chest pain pattern is persistent obtuse pain located in retrosternal area, without obvious tenderness point. No obvious discomfort or positive abdominal physical examination (rebounding pain, muscle guarding, etc.,) was found. The laboratory examination showed leukopenia (white blood cells 3000/μL) with left shift (segmented neutrophils 84%) and elevated C-reactive protein (13.7 mg/dL). The radiographic examination revealed edematous change of colon conduit with luminal stenosis in the right posterior mediastinum [Figure 1]. Chemical colitis was suspected. Two years ago, when he received reconstruction, we performed the anastomosis of colon graft to small bowel (25 cm below the Treitz ligament). Therefore, we reviewed his computed tomography image again and found that, indeed, the edematous change with wall thickening extended from colon graft to small bowel (partial jejunum, about 30–40 cm below the anastomosis site).
Figure 1: Computed tomographic scan showing the colon conduit used for esophageal replacement over the right posterior mediastinum. Thickening wall and edematous change of colon conduit with luminal stenosis were noted (arrow)

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The patient was managed conservatively with antibiotics and oral fasting. The symptoms improved gradually, and he was discharged 6 days later.


  Discussion Top


Ingestion of corrosive substance remains an important public health issue, especially in developing countries. For patients with severe injuries, esophageal or gastric perforations can occur at any time during the first 2 weeks after ingestion. When perforation occurred, emergent surgery including esophagectomy, cervical esophagostomy, gastrectomy, and even more extensive resections, and feeding jejunostomy may be the only chance to survive.[1],[2]

Late sequelae such as esophageal stricture or gastric outlet obstruction usually happen from 3 to 8 weeks after the ingestion. Endoscopic dilation by balloon or bougies can achieve a good outcome. However, when dilation fails to provide an adequate improvement of oral intake, surgical intervention should be considered. The surgery usually includes esophagectomy and partial or total gastrectomy.

In 1911, Kelling and Vuillet introduced the use of the colon as an esophageal substitute.[3] For patients with severe corrosive injury of the esophagus and stomach, the colon is considered a well-functional and durable esophageal substitute.[1],[3] Colon conduit reconstruction is usually advisable at the end of the scarring proves, usually 6 months later.[2] In this case, because of good performance and nutritional status, we performed resection and reconstruction at the same time.

Chemical colitis has been reported to occur after the rectal administration of various chemical agents including alcohol, glutaraldehyde, detergents, hydrogen peroxide, and strong acids/bases. Some cases occurred after accidental contamination of colonoscopy. Others have been implicated in bowel cleansing, suicide attempt, or sexual practices.[4]

Patients of alcohol enema-induced colitis usually suffered from abdominal pain, rectal pain, diarrhea, or hematochezia. Symptoms usually develop within 24 h after introduction. They typically presented with leukocytosis. Colonoscopy may range from mild edema to extensive mucosal hemorrhage or necrosis mucosa. Biopsies show disruption of mucosa, capillary dilation, and neutrophilic infiltration, similar to the findings of ischemic colitis.[4],[5] Because the pathologic findings are nonspecific, a correct diagnosis depends on an appropriate index of suspicion and a thorough history taking. The treatments include discontinuation of exposure, bowel rest, broad-spectrum antibiotics, and possible use of steroids. Most patients had a self-limited course within 7 days.[4]


  Conclusions Top


In this case, for the sequelae of esophageal and gastric corrosive injury, he received esophageal replacement by colon interposition and had a smooth postoperative course. After drinking strong liquor, chemical colitis happened on the colon conduit located in the right posterior mediastinum. After reviewing the literature, we thought that this is the first case being reported. Inflammatory and edematous mucosa compressed the conduit lumen, which caused the symptoms of chest pain, odynophagia, and dysphagia. After conservative and supportive therapy with antibiotics and oral fasting, he recovered from chemical conduit colitis completely.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Cerfolio RJ, Allen MS, Deschamps C, Trastek VF, Pairolero PC. Esophageal replacement by colon interposition. Ann Thorac Surg 1995;59:1382-4.  Back to cited text no. 1
    
2.
Contini S, Scarpignato C. Caustic injury of the upper gastrointestinal tract: A comprehensive review. World J Gastroenterol 2013;19:3918-30.  Back to cited text no. 2
    
3.
Fürst H, Hartl WH, Löhe F, Schildberg FW. Colon interposition for esophageal replacement: An alternative technique based on the use of the right colon. Ann Surg 2000;231:173-8.  Back to cited text no. 3
    
4.
Sheibani S, Gerson LB. Chemical colitis. J Clin Gastroenterol 2008;42:115-21.  Back to cited text no. 4
    
5.
Randolph M, Longacre TA, Gerson LB. Acute colitis secondary to self-administered alcohol enemas: A mimic of ischemic colitis. J Clin Gastroenterol 2005;39:78-9.  Back to cited text no. 5
    


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Discussion
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