%0 Case Reports
%T Delayed esophagopleural fistula after endoscopic injection sclerotherapy for esophageal varices: A case report.
%A Sui M
%A Tang W
%A Wu C
%A Yang J
%A Liu H
%A Huang C
%A Hu X
%A Xia D
%A Yang Y
%J Medicine (Baltimore)
%V 99
%N 3
%D Jan 2020
%M 32011485
%F 1.817
%R 10.1097/MD.0000000000018806
%X <B>BACKGROUND: </B>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.<BR><B>METHODS: </B>An 81-year-old man with hepatic cirrhosis caused by schistosomiasis was admitted with upper gastrointestinal bleeding.<BR><B>METHODS: </B>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.<BR><B>METHODS: </B>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).<BR><B>RESULTS: </B>The patient was completely cured without recurrence during a 6 months of follow-up by comprehensive conservative treatments.<BR><B>CONCLUSIONS: </B>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.