Intestinal Perforation Due to Diverticulitis in Transposed Colon: An Unusual Complication after Esophageal Reconstruction. Case Report Article Sidebar

<p>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.</p>