Harlem Hospital Center New York, NY, United States
Ismail Malik, MD, Eric Alatevi, MD, Joan Culpepper-Morgan, MD Harlem Hospital Center, New York, NY
Introduction: Colonic interposition as a treatment for lye ingestion has significant short and long-term complications. As such, there is a need to follow up closely, affected patients due to the risk of malignant lesions developing in either the transposed conduit or native tissues.
Case Description/Methods: We report a 57-year-old male with a history of childhood ingestion of drain cleaner after which he had an esophagectomy with colonic substitution. He was a smoker with a history of alcohol use disorder. Notably, the patient had no documented history of follow-up surveillance endoluminal evaluations. He presented to the emergency department with dysphagia, sialorrhea, vomiting and gross abdominal distention. Imaging revealed multiple dilated loops of bowel in his right chest and abdomen. He was evaluated for ileus possibly secondary to sepsis with electrolyte derangements. Multiple attempts at nasogastric tube decompression failed. Upper endoscopy with anastomotic dilation and percutaneous endoscopic gastrostomy (PEG) tube for decompression and feeding was achieved. Two sessile adenomatous polyps were discovered and biopsied, one in the interposed colon (fig.1A) and one in the stomach (fig.1C). Due to respiratory failure and persistent ileus, repeat endoscopy to remove the polyps has not yet been attempted.
Discussion: Review of the literature finds 3 premalignant polyps arising in colonic conduits placed for corrosive injury. More frequently, adenocarcinomas are found in patients with colonic conduits who present with dysphagia. Of the 21 cases reported, presenting with adenomas and adenocarcinomas, the average age was 65. Their years since surgery averaged 35 (range: 2-44). Although, exposure of the conduit to undigested food and gastric acid could theoretically accelerate malignant change in the displaced colon, colon cancer development seems to occur at the same age as it would in its natural location. Therefore, we recommend that patients with colonic conduits undergo at least one screening colonoscopy by the age of 50 regardless of the time since surgery.
Figure: Endoscopic images
Ismail Malik indicated no relevant financial relationships.
Eric Alatevi indicated no relevant financial relationships.
Joan Culpepper-Morgan indicated no relevant financial relationships.
Ismail Malik, MD, Eric Alatevi, MD, Joan Culpepper-Morgan, MD. P2375 - Interposition: The Forgotten Colon, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.