A case of a bulging oesophageal bypass
|Photo: NEJM 2016.|
22 April 2016
Doctors have reported the case of a man who developed a hernia through the opening created for his oesophagogastric bypass.
The 60-year-old man visited a clinic with concerns regarding the cosmetic results of the bypass he had had 53 years earlier.
When he was a child, an alkali burn resulting in complete narrowing of his oesophagus (gullet) necessitated the surgery, which was performed by means of colonic interposition, where the colon is used to replace the oesophagus.
“Historically, the subcutaneous (under the skin) route for oesophagogastric bypass was chosen — as in our patient — to avoid additional complications of surgery and anaesthesia” said the case report authors from the University of Freiburg in Germany.
The subcutaneous tunnel created a bulging outline of the patient's intestines — a cosmetic side effect of the surgery.
On physical examination, the doctors discovered the herniation of the proximal jejunum, but a water-swallowing test (see video) revealed normal swallowing function.
“Currently, colonic interposition, as well as subcutaneous positioning of the oesophageal substitute, is rarely performed,” they wrote in the New England Journal of Medicine.
After discussing the risks of an operation, the man declined surgery to repair the hernia.