A 71 year old man underwent retrosternal gastric tube reconstruction following transhiatal oesophagectomy for squamous cell carcinoma. On the second post-operative day, the patient developed a cardiac arythmia with secondary hypotension followed by hypoxaemia necessitating artificial ventilation. Two weeks after surgery, endoscopy revealed massive necrosis of the proximal segment of the gastric tube extending from the anastomosis in the neck to the watershed area. Three weeks later, the patient died and a necropsy was performed. Macroscopic evaluation of the gastric tube revealed a sharply demarcated and fully ossificated proximal segment. Heterotopic ossification was present on histological examination. This condition has only been described in conjunction with primary or metastatic gastric adenocarcinoma. The location of the ossification and the presence of temporary systemic hypoxia suggest that the latter was the main factor responsible for the ossificative response.

*Esophagectomy, Aged, Anastomosis, Surgical, Anoxia/*complications, Carcinoma, Squamous Cell/surgery, Esophageal Neoplasms/surgery, Esophagus/pathology/surgery, Humans, Male, Necrosis, Ossification, Heterotopic/*etiology/pathology, Postoperative Complications/*etiology, Stomach/pathology/*surgery
hdl.handle.net/1765/8559
Journal of Clinical Pathology: an international peer-reviewed journal for health professionals and researchers in clinical pathology
Erasmus MC: University Medical Center Rotterdam

Buscher, H.C, van Lanschot, J.J.B, Mulder, A.H, & Tilanus, H.W. (1995). Heterotopic ossification induced by hypoxia in a retrosternal gastric tube following transhiatal oesophagectomy. Journal of Clinical Pathology: an international peer-reviewed journal for health professionals and researchers in clinical pathology. Retrieved from http://hdl.handle.net/1765/8559