1/84. Squamous cell papillomatosis of esophagus following placement of a self-expanding metal stent.The esophageal self-expanding metal stent has gained widespread acceptance for the management of tracheoesophageal fistulas and the palliative management of malignant esophageal strictures. The complications associated with its use can be classified as either immediate or delayed. The most frequent delayed complications include tumor ingrowth, stent migration, reflux of gastric contents, bleeding, and perforation. This case report illustrates an otherwise unrecognized delayed complication of a self-expanding metal stent. Near complete ingrowth of the stent by squamous mucosal hyperplasia occurred within six weeks of the metal stent's placement. This finding supports the hypothesis that mucosal injury and regeneration underlies the etiology of esophageal squamous cell papilloma formation.- - - - - - - - - - ranking = 1keywords = mucosa (Clic here for more details about this article) |
2/84. shoulder girdle abscess due to streptococcus agalactiae complicating esophageal dilation.bacteremia can result very unusually in significant complications after esophageal dilation. Procedure-related mucosal trauma may be a determinant, whereas pathogenic bacteria primarily originate from the patient's oropharyngeal flora. We describe an unusual case of streptococcus agalactiae bacteremia and shoulder girdle abscess complicating esophageal bougienage. Consideration of specific risk factors and use of scrupulous procedural technique are warranted and will likely reduce pyogenic sequelae.- - - - - - - - - - ranking = 0.5keywords = mucosa (Clic here for more details about this article) |
3/84. Esophageal carcinoma showing a long stricture due to prominent lymphatic permeation: report of a case.Some esophageal diseases such as carcinoma, esophagitis, and collagen diseases have often been reported to show a diffusely thickened esophageal wall in the roentogenogram findings. In the current report, a preoperative upper gastrointestinal series and an endoscopic examination showed a diffusely infiltrative type carcinoma, but other examinations did not suggest any diseases such as esophagitis or collagen diseases which might cause a thickening of the esophageal wall or a constriction of the esophagus. A postoperative histological examination revealed the primary carcinoma to remain only within the mucosal layer, while a large degree of lymphatic vessel permeation reached the adventitia over a wide area. An extraordinary degree of lymphatic permeation spread through the esophageal wall, and stromal fibrosis developed as a result of such lymphatic permeation. These histological phenomena might thus have led to the macroscopic appearance of infiltrative type esophageal carcinoma.- - - - - - - - - - ranking = 0.5keywords = mucosa (Clic here for more details about this article) |
4/84. Dysphagia in oesophageal intramural pseudo-diverticulosis: fibrosis, dysmotility or web?We describe two cases of oesophageal intramural pseudo-diverticulosis associated with a cervical oesophageal web presenting as intermittent dysphagia. In both cases, disruption of the web endoscopically resulted in lasting relief from symptoms. This observation, together with a review of the literature written during the past 39 years, suggests that oesophageal web formation may be under-reported in this condition and may be more important than either dysmotility or submucosal fibrosis and stricturing in the aetiology of the dysphagia seen in these patients. All patients with a radiological diagnosis of oesophageal intramural pseudo-diverticulosis should have an endoscopic examination which may be both diagnostic and potentially therapeutic.- - - - - - - - - - ranking = 0.5keywords = mucosa (Clic here for more details about this article) |
5/84. Ectopic gastric mucosa causing dysphagia due to strictures in a boy.Ectopic gastric mucosa in the upper esophagus has been reported previously in neonatal autopsy series and encountered in adult esophagoscopies. Despite the usual asymptomatic course of the disease, symptomatic adults have been reported. However there is no report of a symptomatic child with ectopic gastric mucosa in the literature. A 12-year-old boy presenting with dysphagia due to strictures resulting from circular patches of ectopic gastric mucosa located in the mid esophagus is reported.- - - - - - - - - - ranking = 3.5keywords = mucosa (Clic here for more details about this article) |
6/84. Congenital esophageal stenosis: report of three cases, literature review, and a proposed classification.The aim of this paper is to report three cases of congenital esophageal stenosis (CES) of different anatomical varieties: (1) stenosis due to tracheobronchial remnants (TBR) involving the lower third of the esophagus; (2) fibromuscular stenosis (FMS) of the middle third; and (3) a membranous diaphragm (MD) involving the lower third. The first two patients were treated by segmental resection of the esophagus and end-to-end anastomosis with dramatic relief of symptoms. The third responded to dilatation. CES is a rare lesion, and about 500 cases are reported in the literature. CES due to TBR and fibromuscular hypertrophy is considered a segmental stenosis, as it involves a length of the esophageal wall, whereas the MD consists of mucosal folds and does not involve its muscular layer. The clinical presentation is varied, and a high index of suspicion is essential to arrive at an early diagnosis. Management depends on the type and severity of the stenosis. Stenosis due to TBR requires segmental resection. FMS may respond to dilatation, but severe degrees of stenosis require segmental excision. MDs usually respond to dilatation or may require endoscopic excision. Segmental stenosis can occur as an isolated lesion or in association with esophageal atresia or stenosis due to a MD. Based on this observation, a classification of CES is proposed.- - - - - - - - - - ranking = 0.5keywords = mucosa (Clic here for more details about this article) |
7/84. Preexisting gastric carcinoid in a gastro-omental free flap.The authors present a 72-year-old man with an extensive medical history including stage III squamous cell carcinoma of the right pyriform sinus diagnosed approximately 10 years before this report. They were asked to evaluate the patient for esophageal reconstruction after local radiation had led to benign stricture of his esophagus and subsequent development of a large, draining esophagocutaneous fistula. A gastro-omental free flap reconstruction of the esophagus and overlying skin defect was complicated by the intraoperative diagnosis of gastric carcinoid obtained from several polyps noticed on the gastric mucosa on routine inspection. This case report signifies the importance of close inspection of all free tissue transfers before interposition. Failure to do so could result in disastrous outcomes.- - - - - - - - - - ranking = 0.5keywords = mucosa (Clic here for more details about this article) |
8/84. Anesthetic implications in epidermolysis bullosa dystrophica.Epidermolysis bullosa is a genetic mechanobullous disease of the stratified squamous keratinizing epithelium that affects the skin and mucous membranes. Its primary feature is the formation of blisters after minor shearing trauma to the skin or mucous membranes that can result in debilitating, even life-threatening scarring. The disease presents special problems for the anesthesia provider because the equipment used to deliver anesthesia and monitor vital signs may cause serious postoperative complications. The challenge is to maintain patency of the airway and use monitoring technology without damaging epithelial surfaces, which could result in permanent scarring. Successful anesthetic management of a patient with epidermolysis bullosa is possible if precautions with anesthetic instrumentation are observed.- - - - - - - - - - ranking = 6.1368125045455keywords = mucous membrane, membrane (Clic here for more details about this article) |
9/84. esophageal stenosis in childhood: dystrophic epidermolysis bullosa without skin blistering due to collagen VII mutations.We report a 9-year-old girl who experienced recurrent dysphagia since infancy. Crohn's disease was suspected because she had aphthous ulcers of the mouth and anal dermatitis with hematochezia. After bougienages of esophageal stenoses and medication for inflammatory bowel disease proved unsuccessful, interdisciplinary re-examination revealed the cause of the symptoms to be an extracutaneous form of dystrophic epidermolysis bullosa, a genetic skin fragility disorder. Dystrophic epidermolysis bullosa is caused by mutations in the COL7A1 gene encoding collagen VII, a protein of the epidermal attachment complex, and typically manifests with trauma-induced skin blistering, scarring, nail dystrophy, and, in some cases, mucosal involvement. The present proband never developed skin blisters but had nail dystrophy and erosions of the oral, esophageal, and genitoanal mucosa, which healed with slight scarring. mutation analysis disclosed compound heterozygosity for recessive mutations in the COL7A1 gene. The paternal mutation 425 A-->G caused abnormal splicing resulting in a premature stop codon. The maternal mutation G2775S led to the substitution of a glycine by a serine in the triple helical domain of collagen VII. This case shows that mucosal disease and esophageal strictures in childhood are not always acquired, but can also represent a genetic defect of dermal-epidermal adhesion, even in the absence of skin blistering.- - - - - - - - - - ranking = 1.5keywords = mucosa (Clic here for more details about this article) |
10/84. Management of congenital esophageal stenosis.BACKGROUND/PURPOSE: The authors report the incidence, diagnosis, and treatment methods of congenital esophageal stenosis (CES) at their institution. methods: A retrospective analysis of 123 patients with tracheoesophageal anomalies in a pediatric hospital between 1980 and 1999 was performed. charts were reviewed for patient demographics, presence of true CES, associated congenital anomalies, method of diagnosis, methods of treatment, and histopathology. RESULTS: Six of the 123 patients (4.9%) had true CES (one patient had 2 separate stenoses). Two patients had isolated CES, one patient had CES with isolated tracheoesophageal fistula (TEF), one patient had CES with isolated esophageal atresia (EA), and 2 patients had CES with EA/TEF. Diagnoses were made with an upper gastrointestinal (GI) contrast study in 5 patients, and one patient had one of 2 stenoses diagnosed by prenatal ultrasound and the other diagnosed intraoperatively. Four of the 7 stenoses were treated with surgical resection, and the remainder was treated with esophageal dilatation. Histopathology from the 4 resected stenoses showed tracheobronchial remnants in 3 specimens and submucosal thickening in 1 specimen. CONCLUSIONS: Although isolated CES is rare (2 of 123 = 1.6%), CES associated with other tracheoesophageal anomalies has a higher incidence (4 of 123 = 3.25%). patients with this lesion should be treated first with dilatation. If ineffective, resection is required.- - - - - - - - - - ranking = 0.5keywords = mucosa (Clic here for more details about this article) |
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