Gastroesophageal reflux (GER) is a common pediatric problem which is not perceived adequately by parents and medical providers. Clinical manifestations such as regurgitation of unprocessed milk, poor weight gain, and respiratory symptoms should alert the physician about this disorder. Endoscopy, 24 hour esophageal pH monitoring, the upper GI series, and scintigraphy are among the used diagnostic modalities of this disorder. Prompt diagnosis and medical or surgical treatment with antireflux procedures as needed can prevent its complications such as Barrett’s esophagus and stricture. In this article we present an 18 month old patient who developed severe esophageal stricture as a complication of prolonged GER because of delayed diagnosis, and underwent a previous unsuccessful antireflux procedure, treated with colon interposition procedure at Tabriz Imam Khomeini Hospital.

Background & Aim: Esophageal replacement is done for patients with long gap esophageal atresia, severe stenosis of esophagus due to gastroesophageal reflux, and burns due to chemical agents. A suitable replacement for esophagus must have the following qualities: appropriate function, no tendency to malignancy, straight direction, no gastroesophageal reflux, and fewer complications. Today gastric tube, stomach, jejenum, and colon are used for esophageal replacement and each has its own advantages and disadvantages. The appropriate time for esophageal replacement is the age of 3-6 months in the case of esophageal atresia. However, when the stenosis needs over a 12-month period for dilation or the length of the stenosis is more than 5 cm and in the case of esophageal burns due to chemical agents and esophageal reflux, replacement seems to be necessary.Patients & Method: In this retrospective study, we examined the results of different methods of esophageal replacement and their complications in Ali-Asghar Hospital from 1996 to 2004. Then the results were compared with the international scientific findings. In Ali-Asghar Hospital, 18 children were operated for esophageal replacement. Among these cases, 3 patients were severe stenosis due to esophageal burns and the others were cases of long gap esophageal atresia. Replacement was done for 15 cases by colon interposition, 2 patients by gastric replacement and one case by gastric tube procedure. The third gastric replacement was performed on complicated patients who had undergone colon interposition before. Colon can be used for esophageal replacement by two methods: isoperistaltic and antiperistaltic. The rate of complications and mortality is higher in antiperistaltic method. Anastomotic leakage and stenosis of the anastomotic line are the most common complications in esophageal replacement. The common causes of mortality are aspiration pneumonia and congenital heart disease.Results: 14 out of 18 patients were male and the rest were female. The range of age to have a replacement operation was 3.5-12 months in the case of esophageal atresia and 15-30 months in the case of GER (gastroesophageal reflux) and esophagitis. Three cases of GER and chemical esophagitis underwent two methods of surgery including gastric replacement(two cases) and gastric tube(one case). 15 cases of esophageal atresia underwent colon interposition. The colon segments used for replacement were right colon in 9, left colon in 5, and transverse colon in 1 case.Conclusion: In Ali-Asghar Children’s Hospital and most other pediatric surgery centers around the world, colon is most commonly used for esophageal replacement. This kind of replacement can be carried out by two methods named isoperistaltic and antiperistaltic. In comparison with antiperistaltic method, the isoperistaltic one is accompanied by fewer complications. However, if colon interposition fails, the best replacement is the whole stomach.

Introduction & Objective: The replacement of segments of esophagus damaged by a tumor or other diseases is usually difficult requiring complex surgical procedures such as replacement of the involved area with stomach, colon, small bowel or composite tissue flaps. In esophageal lesions, this problem is more complicated; whereas, the resection of the segments of trachea and anastomosis of the two ends is a simple and practical procedure with low complications. In this experimental study we resected a piece of cervical esophagus and replaced it with a segment of trachea to find a simple solution for patients suffering from esophageal lesions.Materials & Methods: In 20-30 kg mature adult dogs, 5 cm of trachea was resected while preserving its attachments to the surrounding fibroareolar tissues. Then, 5 cm of esophagus was resected and replaced with the prepared segment of trachea. End to end tracheal anastomosis performed by a combination of interrupted and running vicryle sutures and anastomosis of esophageal ends to the tracheal segment was performed by running nylon sutures.Results: No complication occurred during surgery. Both swallowing function and voice were normal in all three dogs after the operation. Oral diet started the day after operation. No sign of aspiration was seen in clinical and radiographic examinations. On autopsy examination, anastomoses were patent without being narrowed or having abnormal muscosal changes.Conclusions: The replacement of segment of esophagus with an autogenous tracheal segment is a practical procedure with low complications and can probabely be used for the treatment of esophageal lesions in human begins.

Background: Gastrointestinal Cancers are one of the most important causes of mortality of patients in the world as well as in our country. The North of Iran is in Asian belt of esophagus cancer, in addition, in other areas of our country gastric cancer is the most common GI Cancer. Because GI Cancers are common in Lorestan, we decided to study them in patients undergo endoscopy and colonoscopy in Shahid Rahimi hospital.Materials and Methods: This descriptive, cross- sectional research was carried out on patients from the city of Khorram Abad and its suburbs who underwent endoscopy and colonoscopy at Rahimi hospital since Sep 1996 to Sep 1999. Biopsy samples were taken from all patients and analyzed pathologically. The distributions of cancers were determined according to age, sex, type and site of cancer. Findings: Totally, 408 patients out of 3088 patients had GI cancer. The most common site of GI cancer was esophagus (52.93%). Gastric cancer had a lower frequency (37.3%) and colorectal cancer had the lowest frequency (9.57%). The frequency of all GI cancers in men was higher than women. Squamous cell carcinoma (SCC) was the most common esophageal cancer and adenocarcinoma was the most common type of cancer of stomach and colon. Conclusion: Cancers of esophagus, stomach and colon are the most frequent type of GI cancers in studied patients, respectively. Esophagus cancer had the highest frequency and colon cancer had the lowest frequency.

Surgery is the most effective method of treatment in esophageal carcinoma. Due to the wide spread invasion of carcinoma in sub mucosal lymphatic channels, total esophagectomy is mandatory. Open surgery in esophageal carcinoma is with extensive dissection and big incisions in the abdomen and thorax. An excellent alternative for esophageal release in esophageal carcinoma is thoracoscopy. A 54 years old lady complained of dysphagia from 2 months ago and hoarseness since 4 months . She had 5 kg weight loss during this time. Barium swallow showed a filling defect in the middle third of the esophagus which was confirmed by endoscopy. Due to paralysis of the vocal cord, thoracoscopy was planned to rule out any invasion of cancer to the recurrent nerve. Laparoscopic esophageal release was performed successfully. In this patient using thoracoscopy, all of the pleural space was explored effectively. No invasion of tumor to the recurrent nerve or trachea was seen. Esophageal release was performed and 2 small lymph nodes were excised. Thoracoscopic esophageal release is an effective method in esophageal carcinoma wherein thoracic incision is omitted & post operative complications including morbidity are minimal. One-lung anesthesia is mandatory for obtaining a good view.  

Pneumatosis intestinal is isusuallya is a benign condition which may affect any segment of gastrointestinal tract from stomach to rectum.It is also called pneumatosis cystoides intestinal is (PCI). It is best classified into (A) a primary form and (B) a secondary form. Air cysts are found mostly in sub serosa of large bowel. The aim of this study is to present 72-year–old heavy smoker man that referred to emergency department with abdominal pain, nausea, vomiting and decreased appetite for a period of three days duration. With impression of peritonitis due to hallow viscus perforation, as result the patient underwent laparotomy. Abdomen was completely cleaned without any puss or fluid. There were multiple gas containing cysts over the antimesentric colonic wall of the transverse and sigmoid colon. We terminated the operation without any intervention. The patient became symptom free post operatively and discharged from hospital with good condition.