Colonic replacement of the esophagus has been popular over replacing with small bowels for last
2 decades in cases of benign and malignant esophageal pathology because of its technical prepon
derance in view of its good vascular supply and its relative resistancy to aci peptic digestion for
which still there remains some controversy.
Up to 1968 there had been only 11 reported cases of cologastric ulcers in the literatures, and the
authos experienced another one case, on March 28, 1967, in the National Medical Center, Seoul,
a 35-year old Korean housewife who received substernal total bypass procedure using the right
half of colon with terminal ileum for benign stricture of the esophagus due to lye ingestion on
May 27, 1963, and was complicated with acute perforation of cologastrostoma 48 months following
esophageal reconstruction.
In general, the prognosis of the cologastric ulcers is grave with rather sudden onset, and com
plications of the ulcers such as hemorrhage and perforation frequently become the first manifesta
tion of the ulcers. Any preventive measures for this grave complication of esophageal replacement
using the colon should be solved in near future though its occurrence is very rare, and out opinion
for this problem is preventive vagotomy with gastric drainage procedures in cases of high gastric
acidity and gastric acid pepsin. Prevention of redundancy of transplanted colonic segment and of
rupture of pleura during substernal bypassing procedure probably will be factors minimizing this
complication.
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