INTRODUCTION:
Esophago-gastric fistula (EGF) is an exceedingly rare entity. Many etiologies have been associated with the development of EGF: gastroesophageal reflux disease (GERD), esophagogastric surgery, fistulizing Crohn’s disease, esophageal ulcers and carcinoma [1]. Interestingly, laparoscopic Nissen fundoplication, a procedure commonly used to treat refractory GERD, has also been associated with the formation of EGF.
Different theories have been posited in terms of the connection between Nissen fundoplication and EGF development. Intraoperative injuries, compromised blood supply leading to ischemic necrosis and migration of the fundic wrap are plausible etiologies behind EGF development.
Treatment of EGF can be conservative through medical management with anti-secretory drugs, such as proton pump inhibitors (PPIs). When conservative management fails, endoscopic modalities are utilized, such as tissue sealants, stenting and endoscopic clipping. Surgery remains the cornerstone treatment for EGF. However, we herein describe a case of EGF post-laparoscopic Nissen fundoplication that was successfully resolved by virtue of conservative medical treatment with long-term high-dose PPIs.