Perforation of colonic interposition graft in a patient with prior esophagectomy: a case report

Colonic interposition is an established technique for esophageal replacement when gastric pull-up is not feasible. While it provides functional long-term results in selected patients, complications such as ischemia, redundancy, and perforation may occur. We report the case of a 47-year-old male with a history of esophageal perforation and colonic transposition who presented nine years later with acute abdomen. Imaging revealed a complicated diaphragmatic hernia, and exploratory laparotomy showed ischemic and perforated neoesophagus. The patient required urgent resection of the colonic graft, esophagostomy, and negative pressure wound therapy for surgical site infection. Complications of colonic transposition may be early (ischemia, leakage) or late (stenosis, reflux, redundancy, and perforation). Graft ischemia remains a major contributor to postoperative morbidity. Adequate vascularization, careful anastomotic technique, and long-term monitoring are crucial for favorable outcomes. This case highlights a rare but severe late complication of colonic interposition, emphasizing the need for vigilance in long-term follow-up and timely surgical intervention.