PMC5723268_01
An oral contrast enema at postoperative day 7 after esophagectomy showed a straight gastric conduit in the right hemithorax (patient 1).
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Postoperative X-ray oral contrast enema at day 7 (Fig. 1) revealed a straight intrathoracic conduit and an intact anastomosis.
PMC5723268_02
A CT scan demonstrated a dilated and filled conduit with the declive part lying on the right diaphragm (patient 1).
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A computed tomography (CT) scan showed a dilated and filled conduit located in the right hemithorax (Fig. 2).
Prior to reoperation an esophagram demonstrated pyloric dislocation above the hiatus, a redundant conduit partly lying on the diaphragm and delayed emptying of contrast into the duodenum (patient 1).
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An oral contrast X-ray enema after 60 months demonstrated a redundant conduit with its lowermost point lying on the right diaphragm and with herniation of pylorus right above the esophageal hiatus (Fig. 3).
PMC5723268_03
Following reoperation an esophagram demonstrated a straightened conduit with the pylorus reduced below the hiatus and efficient emptying of contrast into the duodenum (patient 1).
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Oral contrast enema (Fig. 4) and gastric emptying test (C-Octanic acid breath test) 2.5 months after surgery were normal, demonstrating a straightened intrathoracic conduit.
PMC5723268_04
In patient 2 postoperative oral contrast enema showed a redundant conduit in the right hemithorax (patient 2).
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As for case 1, the anastomosis was intact at day 7 but with a redundant conduit (Fig. 5).
PMC5723268_05
A partially herniated redundant conduit and pylorus with a considerable horizontal portion lying towards the diaphragm as judged by a CT scan (a) and oral contrast enema (b) (patient 2).
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After 27 months a CT scan (March 16) of the chest and upper abdomen confirmed a redundant conduit with a relatively long distal segment, incuding the pylorus, lying on the diaphragm with only minor passage of contrast into the abdomen (Fig. 6a). An oral contrast enema after 29 months confirmed these findings (Fig. 6b), but now with full retention as there was no passage of contrast into the abdomen.
PMC5723268_06
PMC5723268_07
Six months after last reoperation there was a partial recurrence of conduit herniation (a) but still acceptable emptying or oral contrast into the duodenum (a and b) (patient 2).
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The first oral contrast enema identified a partial recurrence of conduit herniation (Fig. 7a) but still acceptable emptying or oral contrast into the duodenum (Fig. 7a and b).
Thoracic reherniation of the conduit and pylorus (small arrow) and of the transverse colon posteriorly (broken arrow) as demonstated by a coronal CT scan (patient 2).
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CT scan (Fig. 8). Current status after 15 months is that the patient has gained 7 kg of weight, has no persistent retention or pain, and can still eat and drink adequately without supplemental nutrition.