Free jejunal flap transfer for pharyngoesophageal reconstruction in patients with intestinal malrotation: Two case reports

Free jejunal flap transfer is common in head and neck reconstruction, but necrosis remains a complication. A 77-year-old man underwent total pharyngo-laryngo-esophagectomy, bilateral neck dissection, and free jejunal flap transfer. We anastomosed 3 arteries (facial, transverse cervical, and superior thyroid) and 1 vein (jejunal) because the recipient site’s arterial status was poor. On day 2, ultrasonography and visualization revealed that the anastomosed vein was obstructed in the cranial jejunum but the remainder was viable. The region recovered by day 7 and the patient began oral intake on day 30. Ultrasonography revealed that the anastomosed jejunal vein showed no waveform, the facial and transverse cervical arteries showed arterial waveforms, and the superior thyroid artery showed a retrograde venous waveform. The flap had survived because the blood exited through the superior thyroid artery and vein. Thus, additional vascular and arterial anastomoses are options for free flap survival if the vascular status is poor.

Download Full-text

Free Jejunal Flap for Pharyngoesophageal Reconstruction in Head and Neck Cancer Patients: An Evaluation of Donor-Site Complications

Journal of Reconstructive Microsurgery ◽

10.1055/s-0035-1556872 ◽

2015 ◽

Vol 31 (09) ◽

pp. 643-646 ◽

Cited By ~ 10

Author(s):

Shantanu Razdan ◽

Claudia Albornoz ◽

Evan Matros ◽

Philip Paty ◽

Peter Cordeiro

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Cancer Patients ◽

Neck Cancer ◽

Donor Site ◽

Pharyngoesophageal Reconstruction ◽

Free Jejunal Flap

Download Full-text

Carcinoma of the Colon in an Adult with Intestinal Malrotation

Case Reports in Surgery ◽

10.1155/2013/525081 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Michael Donaire ◽

James Mariadason ◽

Daniel Stephens ◽

Sitaram Pillarisetty ◽

Marc K. Wallack

Keyword(s):

Colon Cancer ◽

Incidental Finding ◽

Case Reports ◽

Standard Of Care ◽

Colon Surgery ◽

Intestinal Malrotation ◽

Carcinoma Of The Colon ◽

Common Cancer ◽

The Usa ◽

Laparoscopic Colon

Colon cancer is the third most common cancer in the USA. Intestinal malrotation diagnosed in adulthood was, until recently, a very rare phenomenon. While patients may present with intestinal obstruction or abdominal pain, the diagnosis is now often made as an incidental finding by computed tomography (CT). Surprisingly we found only seven case reports of carcinoma of the colon in patients with malrotation; CT failed to make the preoperative diagnosis in a majority. Laparoscopic colon surgery is rapidly becoming standard of care for colon cancer. We present a case of carcinoma of the colon in an adult that thwarted attempts at laparoscopic resection due to failure to recognize malrotation preoperatively. The literature is reviewed, and the implications of malrotation in patients with colon cancer are examined.

Download Full-text

Acute presentation of intestinal malrotation in adults: a report of two cases

Annals of The Royal College of Surgeons of England ◽

10.1308/147870810x12699662981915 ◽

2010 ◽

Vol 92 (7) ◽

pp. e15-e18 ◽

Cited By ~ 11

Author(s):

Thomas Hanna ◽

Jacob A Akoh

Keyword(s):

Case Reports ◽

Delayed Diagnosis ◽

Adult Life ◽

Intestinal Malrotation ◽

Unusual Complication ◽

Fetal Life ◽

Diagnostic Challenge ◽

Multiple Fractures ◽

Diagnostic Uncertainty ◽

First Case

Introduction Intestinal malrotation is a rare developmental abnormality occurring as a result of incomplete rotation during fetal life. It usually presents in the first few weeks of life, but may persist unrecognised into adult life. We report two interesting cases in elderly patients both characterised by a significant diagnostic challenge due to atypical clinical and radiological signs and in one case an unusual complication following laparotomy. Case Reports The first case was a 64-year-old man initially treated for diverticulitis but at laparotomy was found to have malrotation of the midgut and a perforated left-sided appendicitis. The second case was a 76-year-old woman admitted with multiple fractures and increasing abdominal distension following a fall. Ten days after admission, she underwent right hemicolectomy to treat faecal peritonitis due to multiple caecal perforations complicating volvulus in the presence of midgut malrotation. Conclusions These cases illustrate challenges associated with managing patients with undiagnosed intestinal malrotation. Delayed diagnosis is a common feature in several case reports describing atypical presentation of appendicitis in patients with malrotation. While abdominal CT scan can remove much of the diagnostic uncertainty, the diagnosis of malrotation can be missed unless there is a high index of suspicion.

Download Full-text