Crohn's Disease of the Esophagus: Dilation of Stricture and Fibrin Sealing of Fistulas

Mathis, G.; Sutterlütti, G.; Dirschmid, K; Feuerstein, Michael; Zimmermann, Gert

doi:10.1055/s-2007-1009016

Cited by 15 publications

(6 citation statements)

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“…Esophagopulmonary fistula formation has been reported in 6 patients with CD, and was the result of a chronic inflammatory process in all of them [12, 13, 14, 15, 16, 17]. However, the patient in our case developed esophagopulmonary fistula as a complication following the primary perforation that was located in the prestenotic esophagus.…”

Section: Discussionmentioning

confidence: 61%

Boerhaave-Mimicking Esophageal Perforation with Subsequent Esophagobronchial Fistula Formation as the Primary Manifestation of Crohn’s Disease

Yekebas

Busch²,

Soehendra³

et al. 2000

Dig Surg

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Background: Spontaneous ruptures of the esophagus are rare, but may lead to deleterious courses, even if diagnosed early. Case Report: We report a case of Boerhaave’s syndrome-mimicking esophageal perforation due to a stricture of the distal esophagus as the primary manifestation of Crohn’s disease. Diagnosis was delayed resulting in a complicated clinical course. The presented patient is the first case in the literature with esophageal perforation related to a previously undiagnosed Crohn’s disease that lead to stenosis of the distal esophagus before becoming clinically apparent. Conclusion: Difficulties in differential diagnosis, problems related to initial misdiagnosis and consecutive mismanagment of spontaneous esophageal perforation, and treatment options including nonsurgical approaches are discussed.

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Section: Discussionmentioning

confidence: 61%

Boerhaave-Mimicking Esophageal Perforation with Subsequent Esophagobronchial Fistula Formation as the Primary Manifestation of Crohn’s Disease

Yekebas

Busch²,

Soehendra³

et al. 2000

Dig Surg

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“…48,107 Mathis et al described an esophageal CD stricture dilatation with concomitant fibrin sealant to manage an esophago-bronchial fistula with stricture for over 18 months. 108 There are no reports of intralesional steroid injection in esophageal CD patients in isolation; however, De Felice et al treated patients with combinations of dilatation, biologics, dapsone, steroid injections, steroid gel, and proton pump inhibitors. 48 If ulceration forbids advanced endoscopic therapy, systemic treatment in combination with gastrostomy, either percutaneous or open, may allow the ulcer to heal while still giving enteral nutritional support.…”

Section: Surgical Treatment Of Esophageal Crohn's Diseasementioning

confidence: 99%

Crohn's Disease of the Esophagus, Duodenum, and Stomach

Schwartzberg

Brandstetter

Grucela

2019

Clinics in Colon and Rectal Surgery

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Upper gastrointestinal Crohn's is an under-reported, under-recognized phenotype of Crohn's disease. Routine screening in the pediatric population has shown a higher prevalence compared with adults; however, most adult patients remain asymptomatic with respect to upper gastrointestinal Crohn's disease. For the patients who are symptomatic, medical treatment is the first line of management, except for cases of obstruction, perforation, or bleeding. Though most patients respond to medical therapy, mainly steroids, with the addition of immunomodulators and more recently biologics agents, surgical intervention is usually required only for obstructing gastroduodenal disease secondary to strictures. Strictureplasty and bypass are safe operations with comparable morbidity, although bypass has higher rates of dumping syndrome and marginal ulceration in the long term. Rare cases of gastroduodenal fistulous disease from active distal disease may involve the stomach or duodenum, and esophageal Crohn's disease can fistulize to surrounding structures in the mediastinum which may require the highly morbid esophagectomy.

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“…As an alternative treatment option, fibrin sealants have been used to close the fistula tracts. In one case report a patient with an esophagobronchial fistula and distal esophageal stricture was treated with esophageal dilatation in conjunction with a fibrin sealant [8]. However after 18 months symptoms recurred requiring surgery.…”

Section: Discussionmentioning

confidence: 99%

Crohn’s Disease of the Esophagus: Treatment of an Esophagobronchial Fistula with the Novel Liquid Embolic Polymer “Onyx”

et al. 2006

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Esophageal involvement in Crohn's disease is very rare. In only a small subgroup of these patients -- up to date fourteen cases have been described in the literature -- the course of the illness may be complicated by esophageal fistula formation. The therapy for fistulizing esophageal Crohn's disease so far has been disappointing, recurrence and progression are likely, and surgery still is the primary treatment modality for refractory patients. We here present a case of severe Crohn's disease with an esophagobronchial fistula and the successful closure of the fistula tract with the novel liquid polymer sealant "Onyx". This approach offers a new option for the treatment of this rare complication of Crohn's disease and should be considered if surgery is not possible.

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Crohn's Disease of the Esophagus: Dilation of Stricture and Fibrin Sealing of Fistulas

Cited by 15 publications

References 0 publications

Boerhaave-Mimicking Esophageal Perforation with Subsequent Esophagobronchial Fistula Formation as the Primary Manifestation of Crohn’s Disease

Boerhaave-Mimicking Esophageal Perforation with Subsequent Esophagobronchial Fistula Formation as the Primary Manifestation of Crohn’s Disease

Crohn's Disease of the Esophagus, Duodenum, and Stomach

Crohn’s Disease of the Esophagus: Treatment of an Esophagobronchial Fistula with the Novel Liquid Embolic Polymer “Onyx”

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