Intestinal Perforation Due to Diverticulitis in Transposed Colon: An Unusual Complication after Esophageal Reconstruction. Case Report
Main Article Content
Abstract
Colonic interposition is a well-established technique for esophageal transit reconstruction when the stomach is not viable as a conduit. While it provides acceptable long-term functional results, it carries significant early and late morbidity. Among the rare late complications, diverticular disease in the transposed colon is extremely rare, especially when progressing to acute perforation. We present the case of a 50-year-old male who underwent colonic interposition nine years earlier due to spontaneous esophageal perforation (Boerhaave syndrome), presenting with sudden retrosternal pain, respiratory distress, and altered mental status. Imaging revealed pneumomediastinum and findings consistent with perforation of the transposed colonic segment. Emergency exploratory laparotomy confirmed distal perforation of the colonic graft secondary to complicated diverticulitis. Surgical management included resection of the affected segment, cervical esophagostomy, and gastrostomy. Postoperative course was complicated by intra-abdominal abscess and surgical site infection, requiring two reoperations. The patient was discharged in stable condition after 21 days and is currently functional, awaiting definitive intestinal transit reconstruction.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
I. Veenstra, F., van Duyn, E., Venneman, N. G., & van den Beukel, B. (2025). Complicated diverticulitis: A rare long-term complication after esophagectomy with colon interposition. ACG Case Reports Journal,12(2), e01600.
https://doi.org/10.14309/crj.0000000000001600.
II. Cheng, A., Wright, C., & Fielding, D. (2006). Rare complication of interposed substernal colon. The Annals of Thoracic Surgery,81(2), 729–731. https://doi.org/10.1016/j.athoracsur.2005.07.061.
III. Chirica, M., de Chaisemartin, C., Munoz-Bongrand, N., Halimi, B., Celerier, M., Cattan, P., & Sarfati, E. (2010). Late morbidity after colon interposition for corrosive esophageal injury. Annals of Surgery,252(5), 748–754.
https://doi.org/10.1097/SLA.0b013e3181f5e2a5.
IV. Bonavina, L., Chirica, M., Skrobic, O., Kluger, Y., Andreollo, N. A., Contini, S., & Catena, F. (2015). Foregut caustic injuries: Results of the world society of emergency surgery consensus conference. World Journal of Emergency Surgery,10, 44.
https://doi.org/10.1186/s13017-015-0039-0.
V. Lemos, D. W., & Blencowe, N. S. (2015). A novel complication of a neonatal colonic interposition graft: Diverticulitis. BMJ Case Reports,2015, bcr2015211711.https://doi.org/10.1136/bcr-2015-211711.
VI. Nelson, R. L., & Grayer, D. (1973). Diverticular disease in the transposed colon used for esophagoplasty: Report of two cases. Annals of Surgery,177(1), 70–72.
https://doi.org/10.1097/00000658-197301000-00014.
VII. Bassiouny, I. E., Al-Ramadan, S. A., & Al-Nady, A. (2002). Long-term functional results of transhiatal esophagectomy and colonic interposition for caustic esophageal stricture. European Journal of Pediatric Surgery, 12(4), 243–247.
https://doi.org/10.1055/s-2002-34478.
VIII. Licata, A., Montalto, G., & Craxì, A. (2014). Malignancy arising in a 41-year-old colonic interposition graft. Asian Journal of Surgery, 37(2), 100–102. https://doi.org/10.1016/j.asjsur.2014.01.008.
IX. Martínez, M. A., & Pérez, F. J. (2018). Late complications of colonic interposition in esophageal reconstruction. Cirugía Española, 96(2), 123–129. https://doi.org/10.1016/j.ciresp.2017.09.003.
X. Sánchez, L. M., & Rodríguez, P. A. (2016). Diverticulitis in transposed colon: A case report and literature review. Gastroenterology and Hepatology, 39(7), 459–462.
https://doi.org/10.1016/j.gastrohep.2015.12.002.
XI. Coopman, S., Michaud, L., Halna-Tamine, M., Bonnevalle, M., Bourgois, B., Turck, D., & Gottrand, F. (2008). Long-term outcome of colon interposition after esophagectomy in children. Journal of Pediatric Gastroenterology and Nutrition, 47(4), 458–462.
https://doi.org/10.1097/MPG.0b013e31815ce55c.
XII. Verdugo Salazar, C. I., Kaloyan Lopez, S. Z., Rios, C. R., Bezies, Y. A. N., & Gálvez Coutiño, L. F. (2025). Perforation of colonic interposition graft in a patient with prior esophagectomy: A case report. International Surgery Journal, 12(5), 779–782. https://doi.org/10.18203/2349-2902.isj20251176
XIII. González, J. M., & López, J. A. (2020). Colonic interposition in esophageal reconstruction: Experience in a tertiary care hospital. Spanish Journal of Digestive Diseases, 112(9), 688–694. https://doi.org/10.17235/reed.2020.6630/2019.
XIV. Martínez, M. A., & Pérez, F. J. (2020). Long-term results of colonic interposition in esophageal reconstruction. Chilean Journal of Surgery, 72(6), 502–510.
XV. Sánchez, L. M., & Rodríguez, P. A. (2016). Diverticulitis in transposed colon: A case report and literature review. Gastroenterology and Hepatology, 39(7), 459–462.