1/23. Esophagobronchial fistula combined with a peptic esophageal stenosis.Peptic strictures are a rare complication of severe gastroesophageal reflux disease. An esophagobronchial fistula as a complication of a severe long-term reflux esophagitis with peptic stenosis is here described for the first time: A 43-year-old mentally disabled patient suffered from recurrent bronchopneumonia. endoscopy revealed an esophagobronchial fistula originating in a peptic stricture. Under short-term fasting, intravenous feeding and application of a proton pump inhibitor (PPI) closure of this fistula was achieved within 4 days. Subsequently, dilatation was carried out. The case demonstrates that pulmonary complications in patients with peptic esophageal strictures may not only be due to aspiration of refluxate but--rarely--also to fistulae between the esophagus and the bronchial tree.- - - - - - - - - - ranking = 1keywords = esophagitis (Clic here for more details about this article) |
2/23. Oesophagobronchial fistula caused by varicella zoster virus in a patient with AIDS: a unique case.Human herpesvirus oesophagitis in human immunodeficiency virus positive patients is caused by cytomegalovirus and herpes simplex virus; no cases of oesophagitis and oesophagobrochial fistula as a result of varicella zoster virus (VZV) have been reported to date. This report describes the case of a patient with a 2-3 mm deep oesophageal ulcer whose viral culture was positive for VZV. The patient was treated with acyclovir with resolution of the symptomatology. After the end of the induction treatment, because of the onset of fever and fits of coughing during eating, the patient underwent oesophagography, which showed an ulcer with an oesophagobronchial fistula in the middle and lower third of the oesophagus. This case report stresses the role of VZV infection as a possible cause of oesophagobronchial fistula, a rare but benign condition in patients with AIDS.- - - - - - - - - - ranking = 2keywords = esophagitis (Clic here for more details about this article) |
3/23. Dysphagia in Crohn's disease: a diagnostic challenge.Dysphagia is a rare manifestation in a patient with Crohn's disease. We report on the case of a patient with long-standing Crohn's disease who developed progressive dysphagia over 3 years. endoscopy showed minimal distal oesophagitis with non-specific histological findings. Further investigation with cinematography, barium swallow and manometry established an achalasia-like motility disorder. Biopsies obtained from the oesophagus were non-specific. Balloon dilatation was performed. Initial success was followed by recurrent dysphagia. At repeat endoscopy, an oesophageal fistula was detected. An attempt at conservative medical management failed and oesophagectomy was successfully performed. pathology results of the resected specimen confirmed the suspected diagnosis of oesophageal Crohn's disease. Even if achalasia is suspected in a Crohn's patient, it should be taken into consideration that the motility disorder could be the result of a transmural inflammation with or without fibrosis caused by Crohn's disease.- - - - - - - - - - ranking = 1keywords = esophagitis (Clic here for more details about this article) |
4/23. Infectious necrotizing esophagitis: outcome after medical and surgical intervention.BACKGROUND: Immunodeficiency predisposes to invasive esophageal infections. The treatment of perforation, respiratory fistula, and necrosis due to transmural esophageal infection is guided by anecdote. We wish to determine treatment and outcome of local complications of necrotizing esophagitis. methods: We report our experience over a 7-year period and review published reports since 1976. We treated 4 patients and found 21 reported patients with perforation (11/25), fistula (8/25), and necrosis (6/25) at a mean age of 35 years. Twenty-one patients were immunodeficient (84%) due to acquired immunodeficiency syndrome in 8, acute leukemia in 6, renal transplant in 3, diabetes mellitus, renal failure, and corticosteroids in 1 each. Pathogenic organisms were fungal in 15 cases, viral in 7, and bacterial in 7. RESULTS: Treatment consisted of antibiotic therapy in 13 patients and surgical intervention combined with antibiotic therapy in 12: esophagectomy in 6, esophageal stenting and drainage in 2, drainage alone in 2, and salivary diversion in 2. overall mortality was 48% (12/25). mortality without surgical intervention was 90% (9/10) and with surgical intervention 27% (3/11). One of 6 patients undergoing esophagectomy (17%) died. The difference in mortality was due to sepsis, which was the cause of death in 8 patients treated with medical intervention and only 1 treated with surgical intervention. CONCLUSIONS: Local complications of necrotizing esophagitis have a high mortality due to sepsis. Surgical intervention, in particular esophagectomy, controls sepsis in published case reports and should be considered in selected patients. Further study is required to determine the true prevalence of these complications and the outcome of intervention.- - - - - - - - - - ranking = 6keywords = esophagitis (Clic here for more details about this article) |
5/23. Cerebral embolization resulting from esophageal-atrial fistula.A rare but catastrophic complication of nontraumatic esophageal perforation is the formation of an esophageal-left atrial fistula. Although surgical correction of this condition should be possible, failure to recognize it antemortem has thus far prevented such intervention. A woman with long-standing severe esophagitis, was admitted with hematemesis and acute neurologic abnormalities that progressed to coma and death. A similar picture of chronic esophagitis terminating in uppergastrointestinal-tract bleeding accompanied by neurologic signs was seen in the three previously reported cases as well. Recognition of this symptom complex should permit future cases to be diagnosed clinically, and, it is hoped, corrected.- - - - - - - - - - ranking = 2keywords = esophagitis (Clic here for more details about this article) |
6/23. Tuberculous broncho-oesophageal fistula in the acquired immunodeficiency syndrome.Mycobacteria are the most common bacterial infections occurring in AIDS patients. Although the gastrointestinal tract is commonly involved, there has been only one case report of oesophageal infection. We report a patient in whom oesophageal tuberculosis was the presenting feature of AIDS and review the features of mycobacterial infections in AIDS. The incidence of extrapulmonary infection is common and mycobacterial oesophagitis should be considered in the differential diagnosis of oesophagitis in AIDS.- - - - - - - - - - ranking = 2keywords = esophagitis (Clic here for more details about this article) |
7/23. Double cardia. An unusual sequela of reflux esophagitis with ulcer.We report a patient with acquired "double cardia" (esophagogastric fistula). She was a 76-year-old farmer's widow with severe kyphosis. She presented with postprandial heartburn one month after the initiation of nifedipine and isosorbide dinitrate. Radiologic and endoscopic examinations revealed an esophagogastric fistula, short esophagus with hiatal hernia, Barrett's esophagus with reflux esophagitis, and ulcer. This case shows that repeated reflux esophagitis and esophageal ulcer, complicated with short esophagus and hiatal hernia, can predispose to the formation of esophagogastric fistula.- - - - - - - - - - ranking = 6keywords = esophagitis (Clic here for more details about this article) |
8/23. Esophagoatrial fistula with previous pericarditis complicating esophageal ulceration. Report of two cases and a review of the literature.Sixteen cases of nontraumatic left atrial-esophageal fistulas have been reported previously. These fistulas usually result from chronic peptic esophagitis or cancer. The diagnosis is suggested by the triad of chronic dysphagia, hematemesis, and acute neurologic signs. There may be cardiac manifestations such as pericarditis, atrial fibrillation, or shock. An unusual feature of these fistulas is systemic embolization of food, air, or septic necrotic debris which may result in sudden central nervous system symptoms. All reported cases resulted in death due to hemorrhage, although there was often a variable time interval between the onset of hematemesis and the patient's death. The authors report two additional cases in which an episode of pericarditis preceded fistula development. Based on these 18 cases, the spectrum of esophagoatrial fistulas is reviewed, as well as the signs which may herald fistula development.- - - - - - - - - - ranking = 1keywords = esophagitis (Clic here for more details about this article) |
9/23. Sudden death from perforation of a benign oesophageal ulcer into a major blood vessel.Two cases of sudden death due to perforation of a benign oesophageal ulcer into a major blood vessel are reported. In one man, anaemia and aspiration pneumonitis dominated the clinical picture. He had an oesophageal stricture and a chronic peptic ulcer associated with an incarcerated hiatus hernia. Death was due to haemorrhage caused by perforation of the ulcer into the thoracic aorta. The second patient presented with confusion and falls, backache and indigestion. She had a hiatus hernia and a large benign chronic oesophageal ulcer. Death was due to perforation of the ulcer into the left pulmonary vein. The cases are presented for their rarity, to illustrate the complex and late presentation of problems in geriatric medicine, and as a reminder that reflux oesophagitis can be dangerous.- - - - - - - - - - ranking = 1keywords = esophagitis (Clic here for more details about this article) |
10/23. Tuberculous esophagitis with aortic aneurysm fistula.A patient with treated pulmonary tuberculosis and a thoracic aortic aneurysm was seen with a one-month history of dysphagia. barium swallow revealed a mass in the lower esophagus and extravasation of contrast material into the mediastinum. endoscopy and biopsy specimens showed acid-fast organisms. The patient was treated with antituberculous drug therapy but bled massively from the gastrointestinal tract and died. autopsy revealed an aortoesophageal fistula at the level of the thoracic aneurysm. Histopathological study confirmed that this rare tuberculous lesion of the esophagus caused the fistula.- - - - - - - - - - ranking = 4keywords = esophagitis (Clic here for more details about this article) |
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