Delayed esophagopleural fistula after endoscopic injection sclerotherapy for esophageal varices: A case report

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 d...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research