Open AccessDelayed esophagopleural fistula after endoscopic injection sclerotherapy for esophageal varices
Author(s) -
Mingliang Sui,
Weibing Tang,
Changjiang Wu,
Jinhu Yang,
Huiping Liu,
Chaofa Huang,
Xianzhu Hu,
Damei Xia,
Yixin Yang
Publication year - 2020
Publication title -
medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.59
H-Index - 148
eISSN - 1536-5964
pISSN - 0025-7974
DOI - 10.1097/md.0000000000018806
Subject(s) - medicine , pleural effusion , cirrhosis , esophagus , sclerotherapy , radiology , surgery , stent , fistula , upper gastrointestinal bleeding , esophageal varices , varices , endoscopy , chest pain , portal hypertension
Rationale: Esophagopleural fistula (EPF) is a rare critical life-threatening condition that features high misdiagnosis rate. Although various surgical and conservative techniques have been developed for the treatment of EPF, the mortality rate of EPF remains high. Patient concerns: An 81-year-old man with hepatic cirrhosis caused by schistosomiasis was admitted with upper gastrointestinal bleeding. Diagnoses: Upper endoscopy revealed bleeding large esophageal varices, and endoscopic injection sclerotherapy (EIS) was performed. Two weeks after the EIS was performed, the patient developed pyrexia, left-sided pleuritic chest pain. Air and pleural effusion were showed in the left pleural cavity by high-resolution computed tomography (HRCT), and a linear fistulous communication was noticed from the distal esophagus. These findings were consistent with hepatic cirrhosis, esophageal varices, upper gastrointestinal bleeding, and esophagopleural fistula. Interventions: The patient was intensively treated with endoscopic self-expandable metallic stent (covered-SEMS) implantation and comprehensive treatments (including thoracic closed drainage, antibiotics, nasojejunal nutrition, and antacids). Outcomes: The patient was completely cured without recurrence during a 6 months of follow-up by comprehensive conservative treatments. Lessons: This case indicates that pleural effusion with food residue is a specific finding in EPF. Thorax CT exhibited high sensitivity for the diagnosis of EPF. Endoscopic self-expandable metallic stent implantation and comprehensive conservative treatments may be preferable for the severe liver disease with EPF.