Cervical esophagocolic anastomosis leakage caused by a tension pneumothorax after an esophagocoloplasty for caustic esophageal stricture in a child: a case report

BACKGROUND: Esophageal stricture is the most frequent caustic ingestion sequela, leading to dysphagia and malnutrition. The colon is the most commonly used graft for esophageal reconstruction. The most dreadful early complication of colonic interposition is leakage of cervical esophagocolic anastomosis, which can be caused by several factors. Tension pneumothorax has never been reported in the medical literature. CASE PRESENTATION: A 5 year-old Black African male patient with retrosternal pain and dysphagia was admitted to the department of surgery. The patient had a history of accidental caustic soda powder ingestion 12 weeks ago. Examination of the ear, nose, and throat; thorax; and abdomen revealed normal findings. A preoperative upper gastrointestinal barium swallow test revealed cervical esophageal stenosis and a long thoracic esophageal stricture. Esophagocoloplasty was performed after transhiatal resection of the native esophagus using a transverse colon placed in the posterior mediastinum. The postoperative course was characterized by an enterocutaneous fistula 2 days after surgery. A postoperative upper gastrointestinal barium swallow test revealed a cervical esophagocolic anastomotic leak associated with left-side tension pneumothorax. Left pleural drainage was performed. Cervical esophagocolic anastomotic leakage stopped 2 days after pneumothorax drainage, and the fistula healed early. This clinical evolution suggests that the fistula was caused by the compressive pneumothorax-induced deviation of the interposed colonic segment. The 2-year follow-up showed no complications. CONCLUSION: Leakage of cervical anastomosis is the most common complication of esophageal reconstruction surgery. Many factors influence the occurrence of leakage. To the best of our knowledge, this is the first case of cervical anastomosis leakage due to a tension pneumothorax.