2013-05-14 13:14:45 UTC

A Rash Decision?

May 16, 2013

GuptaNew question from Gastroenterology shares image of 60-year-old man who developed mild neck tenderness and cutaneous erythema adjacent to his left sternoclavicular joint with fluctuating swelling and discomfort following treatment with balloon dilation and intralesional injection of mitomycin C.

GuptaQuestion: A 60-year-old man presented for evaluation of dysphagia secondary to a persistent esophageal stricture. He had a long history of gastroesophageal reflux and subsequently developed a T3N1 esophageal adenocarcinoma four years before his current presentation. He received neoadjuvant radiation/chemotherapy (5-FU/cisplatin) and underwent Ivor-Lewis esophagectomy at an outside institution. Within 12 months of surgery, he developed an anastomotic stricture refractory to endoscopic dilations. He was referred to our institution two years after esophagectomy for further evaluation. Conservative therapies were attempted but provided modest success. Owing to his refractory stricture, he underwent complete gastrectomy with substernal transposition of transverse and left colon with esophagocolostomy, Roux-Y colojejunostomy, and ascending to sigmoid colocolostomy. After surgery, he demonstrated endoscopic and radiologic evidence of a recurrent anastomotic stricture at the esophagocolonic interposition and again failed endoscopic therapy. During his most recent endoscopic session, he was treated with balloon dilation to 12 mm and intralesional injection of mitomycin C. No immediate adverse events were identified. Within 24 hours of the procedure, he developed mild neck tenderness and cutaneous erythema adjacent to his left sternoclavicular joint with fluctuating swelling and discomfort (Figure B).

What is the diagnosis? Gastroenterology has the answer.

More on GERD

Psychotherapy helps patients with chronic digestive disorders

April 17, 2018

New AGA Clinical Practice Update explains benefits of psycho- gastroenterology for patients.

Course for APPs benefits all experience levels

April 16, 2018

AGA's popular course for advanced practice providers will take place Aug. 10 through 12 in Chicago, Illinois.

APPs: Enhance your delivery of patient care

March 28, 2018

AGA's popular course for advanced practice providers will be held this summer in Chicago.