ATILLA ERTAN, MD, MACG, FACPATILLA ERTAN, MD, MACG, FACP

A 64 y/o male with mild and chronic GERD since A 64 y/o male with mild and chronic GERD since childhood who had a progressive dysphagia childhood who had a progressive dysphagia episodes and 30-31 lbs weight loss since May ‘05. episodes and 30-31 lbs weight loss since May ‘05. He was seen by various gastroenterologists who He was seen by various gastroenterologists who had four different EGDs with extensive biopsies had four different EGDs with extensive biopsies and endoscopic dilatations x 4 for a short-segment and endoscopic dilatations x 4 for a short-segment and benign appearing stricture at 32-33 cm from and benign appearing stricture at 32-33 cm from the incisors. Biopsies and imaging studies, the incisors. Biopsies and imaging studies, including chest/abd CTs x 2 & the esophageal including chest/abd CTs x 2 & the esophageal EUS results were unremarkable. He was referred EUS results were unremarkable. He was referred to TMH for further management plans on to TMH for further management plans on October 11 ‘05.October 11 ‘05.

• MED: Lansoprazole caps 30 mg BIDMED: Lansoprazole caps 30 mg BID

• PMH/PSH: UnremarkablePMH/PSH: Unremarkable

• FH: His brother had colon polyps.FH: His brother had colon polyps.

• SH: Married, ENT practitioner, smoked 1 SH: Married, ENT practitioner, smoked 1 pack/d for 40 yrs, drinks 2-3 hard liquors/d pack/d for 40 yrs, drinks 2-3 hard liquors/d for 26 yrs.for 26 yrs.

• ROS: Diminutive few adenomatous colon ROS: Diminutive few adenomatous colon polyps removed in ’02 & diverticula coli.polyps removed in ’02 & diverticula coli.

• PE : Essentially unremarkable.PE : Essentially unremarkable.

64 y/o male with progressive & intermittent dysphagia [1] 64 y/o male with progressive & intermittent dysphagia [1]

64 y/o male with progressive & intermittent dysphagia [2]64 y/o male with progressive & intermittent dysphagia [2]

A 40 y/o female with a h/o Takayasu’s arteritis who A 40 y/o female with a h/o Takayasu’s arteritis who had multiple abdominal vessel graft operations, had multiple abdominal vessel graft operations, including an aorto-renal bypass in ’78 and bypass including an aorto-renal bypass in ’78 and bypass from her ascending aorta to infrarenal abdominal from her ascending aorta to infrarenal abdominal aorta in ’91. She was admitted to a local hospital aorta in ’91. She was admitted to a local hospital with a fever, severe and painless UGIB requiring with a fever, severe and painless UGIB requiring over 30 units of PRBCs in 01’05 who was managed over 30 units of PRBCs in 01’05 who was managed conservatively and after the necessary paper work conservatively and after the necessary paper work referred to TMH for further management plans in referred to TMH for further management plans in late April ‘05.late April ‘05.

40 y/o female with Takayasu’s arteritis & UGIB40 y/o female with Takayasu’s arteritis & UGIB

AORTO-ENTERIC FISTULAS [AEFs] AORTO-ENTERIC FISTULAS [AEFs]

AEFs are rare, but very serious lesions responsibleAEFs are rare, but very serious lesions responsiblefor significant GIB as seen in this case. Althoughfor significant GIB as seen in this case. Althoughthese AEFs most commonly appear 3 to 5 years these AEFs most commonly appear 3 to 5 years after the graft surgery, they may occur after manyafter the graft surgery, they may occur after manyyears of the repair. Two types are recognized:years of the repair. Two types are recognized: Primary AEFs occur de novo between aorta and Primary AEFs occur de novo between aorta and

bowel, most commonly into the 3bowel, most commonly into the 3rdrd portion of the portion of the duodenum. duodenum.

Secondary types occur between a graft and a segment Secondary types occur between a graft and a segment of the bowel. One of the major precipitating factor for of the bowel. One of the major precipitating factor for AEFs is graft infection. The prognosis is poor if the AEFs is graft infection. The prognosis is poor if the diagnosis and reconstructive surgery have been diagnosis and reconstructive surgery have been delayed.delayed.

1.1. Ann Vasc Surg, 14: 668-696, 2000.Ann Vasc Surg, 14: 668-696, 2000.2.2. Semin Vasc Surg, 14: 302-311, 2001.Semin Vasc Surg, 14: 302-311, 2001.

A 66 y/o female with a h/o NSAID associated A 66 y/o female with a h/o NSAID associated GU in ’92 and chronic & PPI dependent GU in ’92 and chronic & PPI dependent GERD for years who also has had a biopsy GERD for years who also has had a biopsy proven ulcerative ileitis and proctitis with proven ulcerative ileitis and proctitis with mild to moderate clinical course since ’93. mild to moderate clinical course since ’93.

Her IBD serology markers were all negative.Her IBD serology markers were all negative. Her second colonoscopy was performed on Her second colonoscopy was performed on

03/22/04 with an oral sodium phosphate 03/22/04 with an oral sodium phosphate bowel cleansing.bowel cleansing.