{Reference Type}: Case Reports
{Title}: Delayed esophagopleural fistula after endoscopic injection sclerotherapy for esophageal varices: A case report.
{Author}: Sui M;Tang W;Wu C;Yang J;Liu H;Huang C;Hu X;Xia D;Yang Y;
{Journal}: Medicine (Baltimore)
{Volume}: 99
{Issue}: 3
{Year}: Jan 2020
{Factor}: 1.817
{DOI}: 10.1097/MD.0000000000018806
{Abstract}: BACKGROUND: 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.
METHODS: An 81-year-old man with hepatic cirrhosis caused by schistosomiasis was admitted with upper gastrointestinal bleeding.
METHODS: 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.
METHODS: 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).
RESULTS: The patient was completely cured without recurrence during a 6 months of follow-up by comprehensive conservative treatments.
CONCLUSIONS: 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.