This chapter highlights the rare but potentially fatal consequences ofoesophageal reconstruction with conduits, which can manifest many months oryears after surgery. While literature reports on such occurrences are rare, the authordescribes a case of, acute dilatation and perforation of a colonic conduit resulting incardiorespiratory collapse. It underscores the urgency of recognising and addressingthese complications. In this instance, a 42-year-old man experienced severe chestpain and cardiorespiratory collapse due to a grossly distended and perforated colonicconduit, necessitating urgent thoracotomy and conduit resection. Despite aggressivetreatment, the patient’s condition rapidly deteriorated, resulting in death. The narrativeemphasises the need for vigilance in monitoring conduit function post-surgeryand underscores the potential gravity of late conduit-related complications, whichdemand prompt diagnosis and intervention to mitigate fatal outcomes.