May 12, 2011 for the 20-year-old boy A Liang (a pseudonym) is the beginning of a nightmare day, because of thirst A Liang will casually take a bottle of “water” on the table to drink, soon vomited more than, and then to the local hospital to wash the stomach. Unbeknownst to him, he had mistakenly taken the “toilet cleaner” that his mother used to clean the family’s toilet. A month later, Liang began to have difficulty swallowing, and in mid-June 2011, he could not even eat a full liquid diet, and could not even swallow saliva, so he had to rely on a jejunostomy tube for liquid food, and his voice was affected, becoming hoarse and low. A-liang has been on a difficult road to find medical help since then, and has been bounced around several large tertiary hospitals in China. Because A-liang’s entire esophagus is severely stenosed, with the narrowest part only 2 mm wide, and the cardia, gastric body, and pylorus are also severely stenosed, many experts have only gently shook their heads after reading A-liang’s medical history, saying there was nothing they could do. A Liang also once despair, is that because of a few mouthfuls of “toilet bowl cleaner” by mistake, from now on can never eat by mouth again? A bright several times thought of suicide. It was the insistence and encouragement of his father, mother and several brothers and sisters that made him give up the idea of dying over and over again. The family saw a media report about the successful laryngeal surgery for a young girl with total esophageal chemical burns, Xiao Jing, from Tianjin, by the surgical team of Zhang Lixi, director of the Department of Thoracic Surgery and Wang Yu, attending physician at the Third Affiliated Hospital of Southern Medical University, and the family rushed to the Third Affiliated Hospital of Southern Medical University that night. After arriving at our hospital, A-liang underwent an interventional angiography to determine the extent and scope of the esophageal and gastric burns. The interventional angiogram showed that A-liang had super high total esophageal and gastric burns, with narrowing of the ectopic scar, narrowing of the gastric lumen, no significant peristalsis of the gastric body, narrowing of the entire esophageal lumen, and unsmooth walls. Interventional balloon dilatation was performed three times repeatedly, and the patient was treated with enhanced nutritional support. The superior mesenteric artery angiography showed that the superior mesenteric artery opened at the level of lumbar 1 vertebra, and the wall of the superior mesenteric artery was smooth without stenosis, and the vascular shape was normal; the inferior mesenteric artery angiography showed that the inferior mesenteric artery opened at the level of the lower edge of lumbar 3 vertebra, and the wall of the inferior mesenteric artery was smooth without stenosis, and the vascular shape was normal. After discussion, the specialists concluded that there was a possibility of preserving laryngeal function. The surgical plan was to free the cervical segment of the esophagus in the neck first, and then make an incision at the lower edge of the segment of the esophagus that was basically normal after balloon dilation under intervention, and place a probe into the mouth end to dilate the diameter of 10 mm or more. In the abdominal surgery group, a sufficient length of interpositional colon was removed and set aside. The interpositional colon was selected from the right hemicocele and transverse colon and anastomosed in the peristaltic direction, and the remaining colon was anastomosed end to end. The interposed colon was lifted to the neck and anastomosed with the lower edge of the cervical esophagus, and the other end of the interposed colon was anastomosed with the proximal jejunum end-laterally, and then the jejunum below the anastomosis between the interposed colon and the proximal jejunum was anastomosed laterally with the jejunum to complete the GI reconstruction. After the operation, the dilating balloon continued to be dilated intermittently for about six months until the stenotic segment was satisfactorily dilated and the patient could enter a semi-liquid diet. The operation lasted for more than three hours, and the previously anticipated difficulties were overcome one by one and successfully concluded. After the postoperative functional laryngeal exercise, Ah Liang can now eat thin rice and steamed buns through the mouth. In order to achieve a successful laryngeal preservation surgery, we believe there are several points: First, preoperative interventional esophagograms and gastrograms are routinely performed to determine the extent and scope of the lesion. In the case of A-liang, the normal imaging may not be able to visualize the esophagus below the entrance due to the severe stenosis at the entrance of the esophagus, thus the esophagus and stomach below the stenosis cannot be further understood; secondly, because the scar tissue is dense and rigid for more than six months, the general balloon dilation method is not effective. Third, in order to prevent the formation of severe scar stenosis near the entrance of the esophagus, gastroscopy and esophagogram should be performed every six months or so after the injury. If the possibility of severe scar stenosis near the esophageal inlet is found, balloon dilation can be performed immediately after early detection to prevent further aggravation of the stenosis; fourth, in order to achieve successful “laryngeal preservation” surgery, it is also important to exercise postoperative laryngeal function. Because of this kind of serious chemical injury near the esophageal entrance, there are often different degrees of pharyngeal nerve damage, and the phenomenon of food aspiration will occur when the patient eats, especially when drinking water and other liquid diet is more obvious; fifth, A-liang’s esophagus and stomach are severely chemically burned, the stomach cavity has been significantly reduced, and the stomach body does not see obvious peristalsis, so we can only choose colonic surgery instead of esophagus, and it is very important to understand the vascular blood supply of the colon clearly before surgery. It is very important to have a clear understanding of the blood supply to the colon before surgery, so as to improve the survival rate of the interposed colon and reduce the incidence of anastomotic leakage and even necrosis of the interposed colon.