Esophagectomy in patients with polysplenia: technical considerations.

We report a case and discuss the special considerations necessary for safe treatment of patients with polysplenia who require esophagectomy for cancer or other conditions. Polysplenia is a form of abnormal arrangement of body organs intermediate between situs solitus and situs inversus, sometimes associated with cardiac abnormalities. Abdominal manifestations include multiple spleens, a preduodenal portal vein, an interrupted inferior vena with azygous continuation, a short pancreas, and intestinal malrotation and malformations with anomalous blood supply. Esophagectomy is complicated in such patients by possible cardiac abnormalities, risk of hemorrhage from the enlarged azygous vein (adjacent to distal esophagus), limited exposure via right thoracotomy because of the dilated azygous venous system, and possibly restricted availability of stomach and colon for esophageal replacement (constraints of mobility stemming from anomalous blood supply and malposition/malrotation).