New Endoscopic Solutions in Managing Phlegmonous Esophagitis

• Type: Another Publication in an International Scientific Journal
• Date: 2022

Authors

Santos, AL (Author) Other; João Santos-Antunes (Author) FMUP; Morais, R (Author) Other; da Costa, EL (Author) Other; Pereira, P (Author) Other; Macedo G (Author) FMUP

Journal

Title: Digestive Diseases

ISSN: 0257-2753

Publisher: Karger

Indexing

ISI Web of Knowledge - 1 Citation

Scopus - 1 Citation

Other information

Authenticus ID: P-00X-HPN

DOI: 10.1159/000521485

Abstract (EN): A 48-year-old woman was admitted in the emergency department due to epigastric pain, nausea, vomiting, and cough. She presented with fever and increased inflammatory parameters. A thoracoabdominal computed tomography (CT) was performed and revealed thickening of the gastric fundus and esophagus, with an apparent laceration in esophageal mucosa and associated dissection of esophageal wall. In upper endoscopy (UE), a bulging of esophageal and gastric walls was observed, with an ulceration in proximal esophagus, suggestive of a perforation. After multidisciplinary discussion, a minimally invasive endoscopic approach was decided. Internal esophageal drainage (IED) was assured with performance of some incisions with Dual-knife (R) (Olympus, Tokyo) along the mucosal and submucosal layers in the esophagus. During the incision, extravasation of pus was evident. One week later, due to clinical worsening and evidence of esophageal perforation in CT scan, UE was repeated. We confirmed esophageal perforation with visualization of two millimetric defects in the proximal esophagus. Significant bulging of the gastric fundus and body was also observed. IED was repeated with mucosal incision of the gastric bulging using Needle-Cut 3V (R) (Olympus, Tokyo), with extravasation of a significant quantity of pus. We decided to proceed to endoscopic vacuum therapy that was performed with sponge placement in the esophageal lumen (Endosponge (R), B. Braun, Melsungen, Germany). UE was repeated 1 week later with sponge removal and confirmation of resolution of esophageal perforation. An improvement of the thickening of gastric fundus and body was also seen. One month later after admission, the patient was discharged home, eating normally, and remains well in the follow-up.

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 4