Esophageal replacement by colon interposition is done for a variety of esophageal diseases. Dysphagia occasionally develops many years after successful colon interposition. Redundancy of the colon graft is usually responsible. We report a patient with onset of dysphagia 24 years after presternal colon interposition for long segment esophageal atresia. Pathophysiology, prevention, and treatment of late colon interposition dysfunction are discussed.