Colonic Interposition for Lye Stricture

Colonic Interposition

• Infection (abscess) is a primary concern, but the patient is afebrile and there are no clinical or laboratory findings to support this diagnosis.
• Air in the soft tissues can be seen with pneumothorax, trauma, and recent biopsy. However, no pneumothoraces are present in this patient admitted for congestive heart failure nor were any recent invasive procedures performed.

The patient had an Upper GI examination because of dysphagia. Spot films demonstrate the patient to be status post esophagectomy with colon interposed between the pharynx and the abdomen.

You may also note that:

• The patient aspirated barium during the study, as evidence by contrast in the tracheal-bronchial tree.
• There is (fixed) tracheal narrowing seen on this, as well as on other, films.
• There is contrast in the right supraclavicular area. While this could have represented a fistula, the barium appears to be external to the patient.

The distal portion of the anastomosis is at the level of the pyloris.

• Esophageal resection combined with colonic by-pass may be performed in the setting of esophageal carcinoma.
  • Strictures secondary to lye ingestion are considered pre-malignant lesions.
• Gastric "pull-through" procedure may obviate the need for colonic replacement.
• Interposed colon is often intra-thoracic.
• Among the many complications are:
  • Leaks or strictures at the anastamotic site.
  • Fistulae.
  • Reflux.
  • Ulceration.
  • Recurrence of disease, e.g., carcinoma.

Ref: Nahum, H., Francois, F., and A. R. Margulis, Radiology of the Postoperative Digestive Tract. Masson Publishing, New York, N.Y., 1979, pp. 2-26.

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