The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
WCIM 2014 SEOUL KOREA 253
Poster Session
PS 1051 Gastroenterology (Gastrointestinal Tract) A Case of Aortoesophageal Fistula Treated with End- ovascular Stent-Grafting in a Patient with Esophageal Cancer and History of Esophageal Stenting
Shin Ju Oh1, Jae Young Jang1
Department of Internal Medicine, Kyung Hee University School of Medicine, Korea1
Hemorrhage into the esophagus due to aortoesophageal communication is very rare but is life-threatening with high morbidity and mortality. Most cases have been associated with aortic aneurysm. The next common cause is ingestion of foreign bodies followed by esophageal malignancy. Due to high mortality, most cases of aortoesophageal fi stula is confi rmed by autopsy. However we reported a case of aortoesophageal fi stula suc- cessfully treated with endovascular stent-grafting in a patient with esophageal cancer, who had received an esophageal stent insertion before.A 62-year-old male with a history of esophageal cancer was presented at the hospital with hematemesis. The pa- tient was diagnosed with cancer in September 2009. During chemotherapy the patient complained of swallowing diffi culty and showed luminal narrowing of the esophagus on endoscopy. Therefore covered esophageal stent was inserted. Subsequently he was admitted due to hemodynamic shock with massive hematemesis that was caused by an aortoesophageal fi stula 7 months after implantation of an esophageal stent. Emergency endoscopy was performed to evaluate and treat under suspicious upper GI bleed- ing. However endoscopy did not show a defi nite bleeding focus because of massive bleeding. After endoscopy, computed tomography (CT) was performed and it showed focal psedoaneurysm at descending aorta and diffuse thinning of esophageal wall(Fig.
1). After being diagnosed with aortoesophageal fistula, he underwent endovascular stent-grafting. The patient recovered and was discharged 2 weeks after implantation without complications such as re-bleeding.This is the case in which the sequence of events of esophageal cancer with aortoesophageal fi stula occurred. Although aortoe- sophageal fistula is usually a fatal disorder because of acute and massive bleeding, previously implanted covered stent in esophagus took an important role in preventing massive bleeding and therefore made an opportunity to treat the patient.
PS 1052 Gastroenterology (Gastrointestinal Tract) A Case of Esophago-Mediastinal Fistula Due to Tuber- culous Mediastinal Lymphadenitis
Jwa Hoon Kim1, Do Hoon Kim2, Hee Young Yoon1, Ji Wan Lee1, Hyungwoo Cho1, Soomin Jeung1, EunJeong Gong2, Hwoon-Yong Jung2, Jin-Ho Kim2
Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Korea1, Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Korea2
Tuberculosis rarely involves the esophagus, and the most esophageal tuberculosis occurs secondary to adjacent tuberculous lymphadenitis. Esophago-mediastinal fi s- tula is very rare complication of tuberculous lymphadenitis. A 28-year-old, previously healthy female visited the outside hospital due to nausea, vomiting, and fever. Chest CT(Computed tomography) showed enlargement of multiple, mediastinal lymph nodes with air density in the mediastinum, and thus suggesting an esophago-mediastinal fi s- tula. Esophagogram showed the extraluminal contrast leakage in cervical esophagus.
Esophagogastroduodenoscopy(EGD) showed the deep ulcer with the fi stula opening at 24cm from the upper incisor teeth. Tuberculosis(Tb) polymerase chain reaction(PCR) on the sputum was positive. A biopsy of the right subclavian lymph node revealed necrotizing granuloma with Tb PCR positive. We diagnosed as tuberculous mediastinal lymphadenitis with esophago-mediastinal fi stula. The referring doctor failed to close the fi stula by endoscopic clipping. Therefore, we decided to use anti-Tb medications to treat fi stula via gastrostomy, because of severe nausea and vomiting. After four weeks, EGD and esophagogram showed that the fi stula opening was closed. The present case highlights the importance of anti-Tb medications in treatment of esophago-mediasti- nal fi stula due to tuberculous mediastinal lymphadenitis.n
