489. COLON DIVERTICULUM IN THE CERVICAL REGION FOLLOWING COLON INTERPOSITION FOR CORROSIVE INJURY: A CASE REPORT

Background

Colon interposition is one of the traditional procedures for esophageal reconstruction following corrosive injury. While the colonic conduit has the potential to restore swallowing function in patients, yet the long term complications are not well documented. we, herby, present a case of colon diverticulum in the neck 17 years after bypass surgery.

Methods

a 22 years old female patient presented with a one year history of gradually progressive grade I dysphagia following a colon bypass surgery performed for esophageal reconstruction for corrosive stricture at the age of 5 years old. Clinical assessment revealed the presence of a swelling on the left side of her neck which increased in size upon swallowing. The patient reported that applying pressure on the swelling was associated with sensation of passage of the food bolus.

Endoscopic and Radiological assessment confirmed the presence of a neck diverticulum at the site of the anastomosis.

Results

Neck exploration was performed. The diverticulum was dissected from the surrounding tissues with particular care to preserve the colon mesentery. The esophago-colic anastomosis was identified. It was found that this anastomosis was performed in an end to side fashion. The diverticulum appeared to be the enlarged side of the colon which was enlarged causing compression on the esophagus (1). This part was resected using a stapler after intraoperative endoscopic assessment (2,3). A second layer of interrupted sutures was performed over the stapled part (4). The postoperative course was uneventful and was associated with improved dysphagia.

Conclusion

Symptomatic colon diverticulum in the neck is a rare long term complication following colon bypass and esophago-colic anastomosis. Particular care should be made when performing it in an end to side fashion. End to end esophago-colic anastomosis could potentially prevent such complication.