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The Authors report a case of acalasic megaoesophagus operated through extramucous myotomy according to Heller 20 years before coming to their observation and with relapse of disphagic symptoms due to serious oesophagitis during the subsequent years, in spite of an interposition of jejunal ansa according to Merendino and an oesophago-gastrostomy after removal of the interposed ansa. As the patient showed a further relapse of the disphagic symptoms, he, at last, underwent a subtotal oesophagectomy with intrathoracic oesophago-colon-plasty. At examination of the operative specimen, as a report added and not evidenced through the preoperative ascertainments, a limited oesophageal neoplastic degeneration at level of the oesophagogastro-stomy was found. The patient died one year and eight months after operation for neoplastic cachexia. The Authors analyse the causes determining the disphagic syndrome after surgical treatment of acalasic megaoesophagus, the therapeutical solutions suggested and the relations between megaoesophagus and oesophageal cancer.

From March 1980 to December 1982, at the 2nd Surgical Clinic of the University of Milan, 47 jejunostomies were performed at the conclusion of a major gastrointestinal surgery to provide immediate post-operative enteral nutrition. A fine needle catheter jejunostomy technique according to Delaney (10) was employed in all cases, using a polythene catheter with an internal diameter of 2.5 mm. inserted into the proximal jejunum using a stainless-steel needle. An elemental diet (13) was adopted and fed through a volumetric infusion pump. Enteral nutrition was usually initiated on the second postoperative day and on average lasted 12 days. No complications connected to positioning, permanence or removal of the catheter were observed. The only inconvenience was represented by obstruction of the catheter with food concretion thus feeding was discontinued in 3 patients. Collateral effects were observed in 9 patients: diarrhoea (5 cases), hyperperistaltis (2 cases), abdominal distension and nausea (1 case). This method of nutritional intake allowed us to: maintain body weight at pre-operative values; obtain a positive nitrogen balance on average the sixth postoperative day; reduce the volume of parenteral support, early suspension and a significant reduction in complications connected with this method.