"This is a very rare and particularly complex case because the patient had lost his entire stomach and no longer had a natural food passage, making the restoration of digestive function a major challenge," Dr Nguyen Xuan Hoa, deputy director of the center for gastrointestinal surgery and pelvic floor disorders at the Viet Duc University Hospital in Hanoi, said on Aug. 23.

The patient was initially treated at a local medical facility in his hometown in Can Tho City, where he underwent total gastrectomy and spent two months in intensive care before being transferred to Viet Duc University Hospital.

An endoscopy showed severe scarring and complete narrowing of his oral cavity and hypopharynx caused by chemical burns.

He had no natural food passage or stomach left.

According to doctors at Viet Duc, the treatment goal was not only to reconstruct his digestive tract but also to restore his ability to eat and drink by mouth. This posed a major challenge for the surgical team.

Doctors perform surgery on the patient at Viet Duc University Hospital in Hanoi. Photo by Nhat Duc

It performed the surgery in two stages.

The first involved creating a new food passage. Doctors from Viet Duc University Hospital worked with specialists from the National Hospital of Otolaryngology to create a new passage through the patient's right pyriform sinus.

The second stage involved reconstructing the food passage. The surgical team used a segment of the colon to create an esophagus, connecting its upper end to the pyriform sinus and its lower end to the small intestine. This created a new digestive tract to replace the damaged passage. The highly complex surgical technique was aimed at preserving swallowing function, restoring the passage of food and minimizing the risk of postoperative complications.

After surgery, the patient had three major anastomoses: the connection between the colon and pyriform sinus, the connection between the colon and small intestine, and the site where the colon was reconnected after a segment was removed for reconstruction.

These sites carried risks of complications such as leakage or disruption if not closely monitored and managed. The medical team therefore continuously assessed the healing of the connections, controlled infection, ensured adequate nutrition, and monitored the patient's overall condition throughout the postoperative period.

One month after surgery, all the anastomoses had healed well and remained stable, and the recovery progressed smoothly.

Doctors said the next stage was crucial to the long-term treatment outcome.

The patient was instructed to undergo swallowing exercises and rehabilitation to adapt to the new food passage. Because the pyriform sinus does not normally serve as a passage for eating, swallowing exercises had to be carried out gradually under the supervision of doctors and rehabilitation specialists to help him eat and drink safely by mouth.

After nearly two months, the patient was able to drink water by mouth and gradually resume eating.

It has not been revealed how he accidentally drank the toilet cleaner.