Perioperative pulmonary aspiration of patients who have had an esophagectomy with a gastric pull-up: the value of preoperative computed tomography of the neck.

Patients who have had an esophagectomy with gastric pull-up are at a higher risk for perioperative pulmonary aspiration due to loss of the esophageal sphincter. Altered neck anatomy following esophagectomy may render the conventional cricoid pressure maneuver unreliable in preventing pulmonary aspiration during induction of general anesthesia. Two patients who suffered perioperative pulmonary aspiration are presented. Retrospective review of their preoperative computed tomography of the neck showed the altered anatomical position of the esophago-gastric connection, causing the cricoid pressure to be ineffective.