Successful Management of a Perforated Interposed Substernal Ileocolon Caused by Right Pleural Hernia.

A 73-year-old man underwent esophagectomy and reconstruction with interposition of the ileocolon through the substernal tract. Ten months later he presented with sudden pain in the right side of his chest that developed after vomiting. Emergency surgical intervention revealed a right pleural hernia of the esophageal substitute and a 3-cm perforation in the cecum. After suturing the perforation directly, we made the redundant ileum straight and pulled down the repaired cecum into the abdominal cavity to prevent intrathoracic leakage, successfully preserving the reconstructed organ. This rare case emphasizes the importance of careful dissection of the pleura and the use of a suitable length of ileocolon for reconstruction.