Successful endoscopic management of iatrogenic mediastinal infection and subsequent esophagomediastinal fistula, following endosonographically guided fine-needle aspiration biopsy.
Complications following endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) biopsy are rare. A 75-year-old man underwent EUS-FNA biopsy of an enlarged mediastinal lymph, which histologic investigation revealed to be a metastasis of a hepatocellular carcinoma. The patient developed the postinterventional complication of suppurative infection within the mediastinum. Under EUS guidance, a pigtail catheter and a soft tube were inserted to respectively drain and rinse the mediastinal lesion for 8 days. The remaining esophagomediastinal fistula was closed by gathering the fistula margins, using band ligations and an Endoloop. The fistula healed with no further complaints or dysphagia. Infection is a possible complication of endoluminal FNA biopsy. An endoscopically guided therapeutic approach can be favored as the initial treatment of choice and as a reasonable alternative that avoids surgical intervention.
Will
U
U
Department of Internal Medicine III, City Hospital, Gera, Germany. uwe.will@waldklinikumgera.de
Meyer
F
F
Bosseckert
H
H
D000368:Aged; D044963:Biopsy, Fine-Needle / Q000009:adverse effects; D019160:Endosonography / Q000009:adverse effects*; D004937:Esophageal Fistula / Q000209:etiology* / Q000628:therapy; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008477:Mediastinal Diseases / Q000209:etiology* / Q000628:therapy; D016156:Respiratory Tract Fistula / Q000209:etiology* / Q000628:therapy; D013530:Surgical Wound Infection / Q000209:etiology* / Q000628:therapy