An unusual complication of retrosternal colon interposition successfully managed by median sternotomy and revision retrosternal pull-through.

An unusual complication of a retro-sternal colonic interposition is described where the redundant retro-sternal section of the graft underwent mesentericoaxial volvulus and infarction 3.5 years after the initial procedure. Access to the graft was obtained via a median sternotomy. At a second procedure the residual distal colon was used to reconstitute the interposition graft via the retro-sternal route without a repeat sternotomy with an excellent outcome. Graft redundancy is an avoidable complication of colon interposition provided certain technical steps in the operation are adhered to. Median sternotomy afforded safe access to the retro-sternal problem with good healing and long-term outcome.