Cases reported "Esophageal Diseases"

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1/59. Treatment of severe esophageal Crohn's disease with infliximab.

    Esophageal ulceration with fistula is an uncommon manifestation of Crohn's disease. Typical presentation of symptomatic esophageal Crohn's disease may include dysphagia, odynophagia, weight loss, and chest discomfort. We present a patient with severe esophageal and skin involvement of Crohn's disease that was progressive despite conventional therapy including prednisone and 6-mercaptopurine. The diagnosis of Crohn's was based on the presence of typical clinical, endoscopic, and pathologic findings, including granulomas in the skin ulcer and the absence of infectious etiologies. The patient had a nearly complete resolution of her esophageal disease with a single infusion of infliximab.
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ranking = 1
keywords = fistula
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2/59. Esophagobronchial fistula after thoracoscopic resection of an epiphrenic diverticulum.

    We report a case of a 54-year-old man presenting with recurrent epiphrenic diverticulum and esophagobronchial fistula 3 years after thoracoscopic diverticulectomy. Surgical correction required transhiatal stapling of the pouch combined with distal esophageal myotomy and Dor fundoplication.
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ranking = 5
keywords = fistula
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3/59. Simplified access for division of the low cervical/high thoracic H-type tracheoesophageal fistula.

    H-type tracheoesophageal fistulas (H-TEF) often are located in the low cervical/high thoracic region where determination of the most appropriate surgical approach is difficult. When it can provide adequate exposure, a cervical incision is preferred because of the likelihood of decreased morbidity. A child with VACTERL association presented with recurrent respiratory problems. Esophagogram showed an H-TEF below the level of the clavicle. A vascular guide wire was placed through the H-TEF with the ends brought out through the mouth. Under fluoroscopic guidance, gentle traction was placed on the wire to bring the fistula into the neck for an easily accessible cervical exposure, thus eliminating the need for a thoracotomy.
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ranking = 6
keywords = fistula
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4/59. 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.
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ranking = 8
keywords = fistula
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5/59. Dysphagia caused by esophageal tuberculosis.

    This report describes two patients with dysphagia who appeared to have esophageal tuberculosis. One patient had a fistula draining into a mediastinal mass. Both patients responded promptly to treatment with tuberculostatics. Surgery was not required. Esophageal tuberculosis is a rare entity.
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ranking = 1
keywords = fistula
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6/59. Expandable metallic stents should not be used in the treatment of benign esophageal strictures.

    Expandable metallic stents have become popular in recent years for the treatment of esophageal strictures. While they are undoubtedly of great value in the palliation of malignant strictures and tracheo-esophageal fistulas, there is concern over their use for the treatment of benign diseases. We report three cases, in which such problems were seen following stent insertion for benign esophageal strictures. All three patients developed further strictures above the stents, one was complicated by a tracheo-esophageal fistula and two stents (in one patient) migrated distally into the stomach. Two of the patients underwent subsequent esophageal surgery. In both cases, this proved extremely difficult and hazardous because of the intense fibrotic reaction induced by the stents. Expandable mesh stents should not be used for the treatment of benign esophageal strictures without careful consideration of the potential problems, which can include rendering the problem inoperable.
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ranking = 2
keywords = fistula
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7/59. Extraluminal migration of a coin in the oesophagus of a child misdiagnosed as asthma.

    Ingestion of a foreign body, the commonest being a coin, is a common problem in children. In most cases the coin will pass uneventfully through the gastrointestinal tract. However, on rare occasions it may become lodged in the oesophagus with subsequent extraluminal migration with the potential for serious complications such as vascular fistula or chronic suppurative infection. A case is presented of extraluminal migration of a coin in the oesophageal associated with abscess formation in a 15 month old boy. This case is particularly important because the presenting symptom of wheezing led to the erroneous diagnosis of asthma, which resulted in a three month delay in investigation and treatment. In addition, it raises the issue of whether to perform chest radiography on newly diagnosed asthmatic patients to rule out the presence of a foreign body and thereby prevent serious complications.
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ranking = 1
keywords = fistula
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8/59. 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.
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ranking = 1
keywords = fistula
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9/59. Crohn's disease of the esophagus.

    Two cases of Crohn's disease involving the esophagus are described. Both patients had Crohn's disease elsewhere. Multiple intramural fistulous tracts are seen in both patients, and this is a characteristic feature of Crohn's disease. One patient developed a spontaneous esophago-bronchial fistula. Even though the esophageal involvement of Crohn's disease is rare, it should be suspected when a chronic esophageal inflammatory lesion develops in a patient who has Crohn's disease elsewhere, especially without hiatus hernia or other chronic disease.
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ranking = 1
keywords = fistula
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10/59. Fatal aortoesophageal fistula in two cases of tight vascular ring.

    Vascular rings are rare vascular congenital anomalies causing oesophageal and tracheal compression. An aortoesophageal fistula is a devastating, in part iatrogenic, complication of vascular rings. It is seen with increasing frequency, and can be misleading, since differential diagnosis with other causes of haematemesis and melaena is often difficult, especially in infants. We report two infants with aortoesophageal fistulas secondary to double aortic arches forming a vascular ring. In both, the diagnosis was missed, and massive haemorrhage led to death. In both cases, the fissuration on the oesophageal and aortic sides of the fistula had sharp edges, highly suggestive of an iatrogenic laceration caused by manipulation of nasogastric tubes. The key for the diagnosis of vascular rings is, therefore, clinical suspicion and awareness of this condition. Prompt identification in infants with stridor, wheezing, or respiratory distress can prevent prolonged intubation, thus avoiding the formation of an aortoesophageal fistula and hopefully preventing a fatal outcome.
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ranking = 8
keywords = fistula
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