Digestive Endoscopy 2014; 26: 680–682
Letters, Techniques and Images
Double lumen esophagus: a rare complication of nasogastric tube?
a
Double lumen esophagus is an extremely rare endoscopic finding. Recently, Samiullah et al. reported a case as a complication of gastroesophageal reflux disease.1 We report a case of double lumen esophagus in a patient with nasogastric tube feeding after bleeding duodenal ulcer. An 80-year-old Japanese man was referred to Mitsubishi Kobe Hospital because of pneumonia and colitis. The patient had a previous medical history of right lung cancer (received lobectomy 24 years ago). On day 2 of hospitalization, hematemesis occurred. Endoscopic findings showed multiple ulcers from the superior to the descending part at the duodenum with bleeding from the visible vessel at the descending part. Endoscopic hemostasis with clipping was carried out. On day 4, endoscopic hemostasis with clipping of the visible vessel at the descending part was again carried out. Both endoscopic examinations revealed a single lumen esophagus (Fig. 1). After the second hemostasis, the patient was free from symptoms of gastrointestinal bleeding. As a result of mechanical ventilation, a nasogastric tube was placed. Proton pump inhibitor was given i.v. or enterally. On day 227, endoscopic examination was carried out for gastrostomy. At endoscopy (GIF-H260, 9.8 mm in tip diameter; Olympus, Tokyo, Japan), the upper portion of the esophagus appeared to be normal. At 30 cm from the incisor teeth, the esophageal lumen revealed a double lumen (Fig. 2a). The endoscope could not be advanced through either lumen into the stomach; therefore, an ultrathin endoscope was used (GIF-N260, 4.9 mm; Olympus). The latter
a
b
Figure 1 Endoscopy (GIF-Q260J; Olympus, Tokyo, Japan) shows a single lumen esophagus on day 2 (a; the first endoscopy shows the esophagogastric junction) and day 4 (b; the second endoscopy shows the middle esophagus).
bs_bs_banner
680
b
Figure 2 (a) Endoscopy (GIF-H260; Olympus, Tokyo, Japan) reveals a double lumen esophagus. Nasogastric tube was placed through the right side (R) lumen. (b) Endoscope (GIF-N260; Olympus) was advanced through the right side lumen, and reveals a double lumen esophagus in the cardia of the stomach.
could be passed through the esophagogastric junction (Fig. 2b). Length of the double lumen was approximately 5 cm. Neither lumen showed any ulceration, stricture, or tumor. On day 398, the patient died of pneumonia. Previous reported cases have been associated with previous esophagogastric surgery, persistent gastroesophageal reflux, esophageal ulcer or esophageal carcinoma.1–5 Although pathological findings were not obtained, long-term placement of nasogastric tubing may have created a double lumen of the esophagus in the present case. Mitsuo Tashiro,1,2 Kosaku Matsuda1,2 and Ryosuke Ueda2 Departments of 1Gastroenterology and 2Internal Medicine, Mitsubishi Kobe Hospital, Kobe, Japan doi: 10.1111/den.12314
REFERENCES 1 Samiullah S, Samad F, Tang YM et al. Double lumen esophagus: A rare complication of gastroesophageal reflux disease. Dig. Endosc. 2014; 26: 282–4. 2 Mihas AA, Slaughter RL, Goldman LN, Hirschowitz BI. Double lumen esophagus due to reflux esophagitis with fibrous septum formation. Gastroenterology 1976; 71: 136–7. 3 Fleming JL, DiMagno EP. Double lumen esophagus: Presentation of esophagogastric fistula, a rare complication of fundoplication. Dig. Dis. Sci. 1986; 31: 106–8. 4 Choudhry U, Shenoy V, Choudhry R, Gopalswamy N. Double lumen esophagus: Formation of a new lumen or septation of the existing one? South. Med. J. 1996; 89: 538–41. 5 Hussain SZ, Abbas AE, Brown MF et al. Surgical reconstruction of the double lumen esophagus. J. Pediatr. Surg. 2013; 48: 661–4.
© 2014 The Authors Digestive Endoscopy © 2014 Japan Gastroenterological Endoscopy Society
Letters, Techniques and Images
Double lumen esophagus: a rare complication of nasogastric tube?
a
Double lumen esophagus is an extremely rare endoscopic finding. Recently, Samiullah et al. reported a case as a complication of gastroesophageal reflux disease.1 We report a case of double lumen esophagus in a patient with nasogastric tube feeding after bleeding duodenal ulcer. An 80-year-old Japanese man was referred to Mitsubishi Kobe Hospital because of pneumonia and colitis. The patient had a previous medical history of right lung cancer (received lobectomy 24 years ago). On day 2 of hospitalization, hematemesis occurred. Endoscopic findings showed multiple ulcers from the superior to the descending part at the duodenum with bleeding from the visible vessel at the descending part. Endoscopic hemostasis with clipping was carried out. On day 4, endoscopic hemostasis with clipping of the visible vessel at the descending part was again carried out. Both endoscopic examinations revealed a single lumen esophagus (Fig. 1). After the second hemostasis, the patient was free from symptoms of gastrointestinal bleeding. As a result of mechanical ventilation, a nasogastric tube was placed. Proton pump inhibitor was given i.v. or enterally. On day 227, endoscopic examination was carried out for gastrostomy. At endoscopy (GIF-H260, 9.8 mm in tip diameter; Olympus, Tokyo, Japan), the upper portion of the esophagus appeared to be normal. At 30 cm from the incisor teeth, the esophageal lumen revealed a double lumen (Fig. 2a). The endoscope could not be advanced through either lumen into the stomach; therefore, an ultrathin endoscope was used (GIF-N260, 4.9 mm; Olympus). The latter
a
b
Figure 1 Endoscopy (GIF-Q260J; Olympus, Tokyo, Japan) shows a single lumen esophagus on day 2 (a; the first endoscopy shows the esophagogastric junction) and day 4 (b; the second endoscopy shows the middle esophagus).
bs_bs_banner
680
b
Figure 2 (a) Endoscopy (GIF-H260; Olympus, Tokyo, Japan) reveals a double lumen esophagus. Nasogastric tube was placed through the right side (R) lumen. (b) Endoscope (GIF-N260; Olympus) was advanced through the right side lumen, and reveals a double lumen esophagus in the cardia of the stomach.
could be passed through the esophagogastric junction (Fig. 2b). Length of the double lumen was approximately 5 cm. Neither lumen showed any ulceration, stricture, or tumor. On day 398, the patient died of pneumonia. Previous reported cases have been associated with previous esophagogastric surgery, persistent gastroesophageal reflux, esophageal ulcer or esophageal carcinoma.1–5 Although pathological findings were not obtained, long-term placement of nasogastric tubing may have created a double lumen of the esophagus in the present case. Mitsuo Tashiro,1,2 Kosaku Matsuda1,2 and Ryosuke Ueda2 Departments of 1Gastroenterology and 2Internal Medicine, Mitsubishi Kobe Hospital, Kobe, Japan doi: 10.1111/den.12314
REFERENCES 1 Samiullah S, Samad F, Tang YM et al. Double lumen esophagus: A rare complication of gastroesophageal reflux disease. Dig. Endosc. 2014; 26: 282–4. 2 Mihas AA, Slaughter RL, Goldman LN, Hirschowitz BI. Double lumen esophagus due to reflux esophagitis with fibrous septum formation. Gastroenterology 1976; 71: 136–7. 3 Fleming JL, DiMagno EP. Double lumen esophagus: Presentation of esophagogastric fistula, a rare complication of fundoplication. Dig. Dis. Sci. 1986; 31: 106–8. 4 Choudhry U, Shenoy V, Choudhry R, Gopalswamy N. Double lumen esophagus: Formation of a new lumen or septation of the existing one? South. Med. J. 1996; 89: 538–41. 5 Hussain SZ, Abbas AE, Brown MF et al. Surgical reconstruction of the double lumen esophagus. J. Pediatr. Surg. 2013; 48: 661–4.
© 2014 The Authors Digestive Endoscopy © 2014 Japan Gastroenterological Endoscopy Society
