Esophageal Tuberculosis Presenting as Intramural Esophagogastric Hematoma in a Hemophiliac Patient
Tanin IntragumtornchaiSachapan IsrasenaVichai BenjacholamardSukalaya LerdlumSunpetch Benjavongkulchai
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Abstract:
A spontaneous intramural esophagogastric hematoma developed in a patient with hemophilia A. The hematoma did not resolve after antihemophiliac factor replacement but ruptured into the stomach causing massive gastrointestinal bleeding. The associated enlarged right tracheobronchial gland and the histopathological finding of fibrocaseating granuloma at the esophagogastric junction indicated that the primary disorder was esophageal tuberculosis. The whole process responded rapidly to antituberculous treatment.Keywords:
Esophagogastric junction
In order to avoid confusion in categorizing malignant lesions for surgical treatment, a definition and criteria of carcinomas significantly involving the esophagogastric junction (ECJ-Ca) and those of gastric cardia less significantly involving the esophagogastric junction (eC-Ca) are proposed, devised as this study was from a practical viewpoint. A comparative analysis of carcinomas of these groups was carried out, the control group being those carcinomas situated mainly in the upper third segment of the stomach but not involving the esophagogastric junction (C-Ca). Carcinomas of these regions can be determined by the EGJ-Index (EGJ-I) calculated through the following formula: EGJ-Index = [( Length of the esophageal portion of the lesions)/(length of the of the esophageal portion + gastric portion of the lesion])x1,000. Thus lesions of these regions are easily and practically classified as follows: [I]: EGJ-Ca 250 less than or equal to EGJ-I less than or equal to 750, 59 cases; ( II]: eC-Ca 0 less than or equal to EGJ-I less than 250, 88 cases; [III]: C-Ca 0 = EGJ-I, 208 cases. We found these categories quite suitable for practical use.
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The esophagogastric junction is a muscle, not a mucosal, junction. The boundary of the esophagus is at the upper esophageal sphincter and lower esophageal sphincter (LES) at the oral and anal ends, respectively. The distal end of the LES is the esophagogastric junction. Fine palisade vessels occur in the mucosa above the LES, and the esophagogastric junction is at the distal end of this palisade zone. The esophagogastric junction is defined as the part changing into the lumen seen in radiographic, examination or in surgically resected specimens. It is extremely difficult to identify the esophagogastric junction pathologically, requiring special effort.
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Surgical resection with lymphadenectomy is the mainstay of treatment for all resectable esophagogastric junction tumors, prior to systemic generalization of the disease.This makes accurate pre-treatment staging and classification of the tumors most demanding.A wellestablished and internationally accepted classification for adenocarcinomas of the esophagogastric junction (AEG) helps to choose the appropriate surgical approach and to make results from different institutions comparable.Distal esophageal adenocarcinomas (AEGⅠ) are distinguished from true cardia carcinomas (AEG Ⅱ) and subcardiac gastric cancers (AEG Ⅲ).Substantial advancements in this surgical field during the preceding decades have clearly revealed that individualization of the surgical strategy is the key to successfully approaching these entities.In this review we discuss the surgical management of esophagogastric junction tumors with a tailored surgical strategy.
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Overview Upper gastrointestinal tract cancers originating in the esophagus, esophagogastric junction (EGJ), and stomach constitute a major health problem around the world. An estimated 37,640 new cases of and 25,070 deaths from upper gastrointestinal cancers occurred in the United States in 2010.1 A dramatic shift in the location of upper gastrointestinal tumors has occurred in the United States.2,3 Changes in hisNCCN
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