METHODS:
An esophagogastroduodenoscopy (EGD) revealed a concentric patch of gastric mucosa around 2-cm in diameter with an opening-like orifice (black arrow) just above the gastro-esophageal junction (white arrow), a finding known as the “double-lumen sign” (Figure 1). A small opening-like orifice was also detected upon gastric retrograde vision (Blue arrow, figure 2). A diagnosis of esophagogastric fistula was made. The Nissen fundoplication was intact.
Biopsies were taken from the circular patch of gastric mucosa which revealed non-specific inflammatory changes. No granulomas were appreciated. No viral, fungal or mycobacterial organisms were noted.