Cases reported "Peptic Ulcer"

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1/11. Esophageal inflammatory pseudotumor mimicking malignancy.

    A 54-year-old man with a complaint of dysphagia was found to have a prominent stricture in the proximal esophagus. A biopsy of the stenotic area indicated sarcoma, leading to subtotal esophagectomy. The surgically removed esophagus demonstrated a well-defined intramural mass, consisting of a mixture of fibroblastic cells with bland cytological appearances and inflammatory cells. Reflux esophagitis which was present distal to the stricture seemed to play a role in the development of this inflammatory pseudotumor.
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2/11. Perforating Barrett's ulcer resulting in a life-threatening esophagobronchial fistula.

    Perforating benign ulcer is a very rare complication of Barrett's esophagus. This report presents the management of a patient with a Barrett's ulcer that penetrated into the left mainstem bronchus resulting in a life-threatening bronchial esophageal fistula. This rare complication was successfully managed by using a staged surgical approach, which combined the principles used for treating benign esophagorespiratory fistulas and perforating Barrett's ulcers.
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3/11. Anastomotic ulcer-induced aortoenteric fistula after esophagogastroplasty.

    A 67-year-old woman underwent an esophagogastrectomy and esophagogastrostomy for carcinoma of the distal esophagus. She died of massive hematemesis and exsanguination on the 14th postoperative day. An acute peptic ulcer-induced aortoenteric fistula was present at the anastomotic line. The literature on peptic ulcer-induced aortoenteric fistulas after esophagogastroplasty is reviewed.
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4/11. peptic ulcer-induced acute aortogastric fistula occurring 7 years after a pharyngogastrostomy following a resection for carcinoma of the esophagus: report of a case.

    A 46-year-old woman underwent a pharyngogastrostomy, following a laryngoesophagectomy for esophageal carcinoma. Although she had been disease-free for 7 years, she subsequently was admitted to undergo a workup due to fever along with chest and back pain. A few days after admission, the patient suddenly vomited a large volume of blood and went into shock. Bleeding was stopped with a Sengstaken-Blakemore tube, and an emergency thoracotomy was performed. A fistula between the thoracic aorta and an ulcer of the gastric tube was identified. We decided to close the aortic lesion directly because the adhesions were extremely dense and her blood circulation was poor. One week later, we resected the thoracic part of the gastric tube, debrided the fistula, and wrapped the aortic lesion with a patch. However, on the 18th postoperative day, she developed massive hematemesis due to rupture of an infected pseudoaneurysm in the thoracic aorta and died.
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ranking = 2
keywords = esophagus
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5/11. esophagitis in an adolescent patient with Crohn's disease after changing treatment from prednisolone to budesonide.

    Studies have demonstrated that budesonide is effective in the treatment of active Crohn's disease. Due to its extensive hepatic metabolism, budesonide has much lower adverse events compared to prednisolone. Consequently, the low systemic availability restricts its application to Crohn's disease of the terminal ileum and the colon. Esophageal ulceration is a rare complication of Crohn's disease. This article describes the case of a young lady who presented at the age of 16 with active Crohn's disease of the terminal ileum and the colon without dysphagia or pain in the chest. Her disease was successfully treated with prednisolone for almost two years. Because of weight gain, acne, and moon face she was switched to budesonide. A few days later she presented with intractable pain of the esophagus, dysphagia, and inability to eat. endoscopy demonstrated aphthous ulcerations of the esophagus and the histology was compatible with Crohn's disease. After two weeks of treatment with prednisolone all symptoms resolved and at follow-up gastroscopy ulcers had disappeared.
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keywords = esophagus
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6/11. adenocarcinoma arising in Barrett's esophagus after total gastrectomy.

    A 64-yr-old Japanese male who underwent a partial gastrectomy for a duodenal ulcer at the age of 21, a total resection of the remnant stomach for a stomal ulcer at age 25, and in whom Barrett's esophagus was diagnosed at age 47, was found to have a tumor at the distal esophagus and was operated on by thoracic esophagectomy. The tumor was a well to moderately differentiated adenocarcinoma invading down to the muscularis propria. The entire esophageal mucosa in the resected specimen was lined by columnar epithelium. This tumor was thought to derive from the Barrett's esophageal epithelium.
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ranking = 3
keywords = esophagus
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7/11. Gastroatrial fistula following esophagectomy with esophagogastrostomy.

    A case of gastroatrial fistula following resection of a carcinoma of the mid-esophagus and re-establishment of the alimentary tract with a cervical esophagogastrostomy is presented. Three episodes of moderate upper gastrointestinal hemorrhage secondary to chronic peptic ulcer of the stomach placed in the thorax occurred three years after the operation. At this time, the patient was also admitted to the hospital with diagnosis of pericarditis of unknown etiology. Three years later the patient had a massive and fatal episode of upper gastrointestinal bleeding.
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ranking = 0.5
keywords = esophagus
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8/11. Barrett's ulcer and treatment with cimetidine.

    Of seven patients with Barrett's esophagus, two had acute upper gastrointestinal (GI) tract bleeding, two had slow chronic upper GI tract bleeding; and three had dysphagia and weight loss. At upper GI tract endoscopy, 1- to 2-cm ulcers were seen in all seven patients in the distal esophagus. Four of the seven patients also had stricture of varying severity in the distal esophagus. Serial esophageal mucosal biopsy specimens in all seven patients revealed specialized columnar epithelium distal to 28 cm from the incisor teeth. Five of the seven patients were treated with intensive antacid therapy for eight weeks; but the ulcers had not healed after this period of treatment as assessed endoscopically. These five patients and two more then started therapy with cimetidine, 1.2 g per day. Repeat endoscopy four weeks and eight weeks after institution of cimetidine therapy revealed complete healing of the esophageal ulcers in six of the seven patients. One patient needed 16 weeks of cimetidine therapy before his ulcer had healed completely. cimetidine therapy was not effective in preventing restricture of the esophagus. Two patients underwent biopsy 18 months after successful treatment; gastric epithelium had not reverted to squamous epithelium.
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ranking = 2
keywords = esophagus
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9/11. Pharmacotherapy of an ulcer in Barrett's esophagus: carbenoxalone and cimetidine.

    A 70-year old man is described who had specialized columnar epithelium in the esophagus up to the upper esophageal sphincter, 19 cm from the incisor teeth. The patient had a small sliding hiatus hernia but the lower esophageal sphincter was located at 39-41 cm. Above the sphincter the patient had large peptic ulcers which failed to heal after 1 year of a conventional antireflex regimen. Carbenoxalone sodium administration led to healing in 3 months. However, the ulcers recurred after discontinuation of the drug. On a second attempt carbenoxalone effected modest healing but was stopped because of hypertension and hypokalemia. cimetidine therapy led to complete healing of the the ulcer within a month. The authors concluded that both carbenoxalone and cimetidine are useful in the treatment of an ulcer in Barrett's esophagus. However, cimetidine may be more rapidly effective and does not produce dangerous side effects.
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ranking = 3
keywords = esophagus
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10/11. Duplication of the pylorus found concomitantly with achalasia: congenital or peptic etiology?

    A patient is presented with true duplication of the pylorus and concomitant achalasia of the esophagus. This patient has never had peptic ulcer disease and is suspected to have a double pyloric anomaly as a congenital abnormality rather than the result of peptic disease and scarring.
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ranking = 0.5
keywords = esophagus
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