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Gut. 2007 September; 56(9): 1231.
PMCID: PMC1954992

EDITOR'S QUIZ: GI SNAPSHOT

Answer

From question on page 1225

An oesophagogastric fistula was found by the double‐contrast barium. At endoscopy, the patient had an almost double‐lumen oesophagus, with the lumen of the fistula as large as the true oesophagogastric lumen. The tone in the sphincter caused the endoscope to enter the fundus via the fistula rather than the normal route. At reoperation, the fistulous track was found and resected. No other causative factor could be identified. The symptoms resolved completely following the second operation and the patient was discharged.

Fistulae following operations on the gastro‐oesophageal junction are rare, but should be considered in patients who have recurrent symptoms of gastro‐oesophageal reflux disease following operations combining fundoplication or fundoplasty with other procedures on the oesophagus or the gastrooesophageal junction. In our patient, the aetiology was presumably ischaemic necrosis of the oesophageal muscle tube within the sutures used to secure the wrap.


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