Benign Esophageal Ulcer with Esophago-Mediastinal Fistula Successfully treated by Esophagectomy

Satoru Matono, Toshiaki Tanaka, Susumu Sueyoshi*, Yuichi Tanaka, Tatsuji Tsubuku, Kohei Nishimura, Kazuo Shirouzu and Hiromasa Fujita

Department of Surgery, Kurume University School of Medicine
Department of Surgery, Omuta City General Hospital*

We report a case of benign esophageal ulcer with an esophagomediastinal fistula treated by esophagectomy. A 49-year-old man with an esophageal ulcer who had undergone conservative therapy with H₂-blocker or PPI at a local hospital since September 1997 was referred in July 2003 due to deterioration of the ulcer and esophageal stenosis developing in response to medication. The cause was not clarified by 24-hour pH monitoring, pathological test, or other examination, indicating surgery that the man declined. He continued to undergone endoscopic balloon dilation and PPI administration, but suffered back pain and severe dysphagia in August 2007 due to mediastinitis after the ulcer perforated, necessitating surgery, which he agreed to. During esophagectomy via right thoracotomy, the ulcerous esophagus was found to tightly adhere to adjacent tissues. The ulcer perforated reached to the aorta. The postoperative course was uneventful, and he was discharged on postoperative day 27.

Key words
benign esophageal ulcer, esophagomediastinal fistula, esophagectomy

Reprint requests
Satoru Matono Department of Surgery, Kurume University School of Medicine
67 Asahimachi, Kurume, 830-0011 JAPAN

Accepted
April 23, 2008

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