BARRETT-ESOPHAGUS AND PERFORATION OF GASTRIC TUBE ULCERATION INTO THEPERICARDIUM - A LATE COMPLICATION AFTER RECONSTRUCTION OF ESOPHAGEAL ATRESIA

15 years after replacement of atretic segment with a gastric tube, per foration of an intrathoracic gastric tube ulcer into the pericardium, oesophago-pericardial fistula and severe mediastinitis developed in a 17-year-old male after reconstruction of oesophageal atresia using a r etrosternal Heimlich-tube with a cervical oesophagogastric anastomosis . For six years he suffered from reflux oesophagitis and had Barrett's metaplasia in the cervical oesophagus. The patient had previously had one unsuccessful attempt to correct the oesophageal atresia at the ag e of two years using transverse colon. The two stage treatment include d subtotal oesophagectomy, pericardiotomy, cervical oesophagostomy, ga strostomy, mediastinal and pericardial irrigation with antibiotics. Af ter healing of the mediastinitis, the continuity of the alimentary tra ct was restored by using an isoperistaltic subcutaneous ileocolic segm ent. After a follow-up of five years the patient is well, without any oesophageal symptoms.