식도종격동누공을 형성한 결핵 종격동 림프절염 1예 (Esophago-Mediastinal Fistula Due to Tuberculous Mediastinal Lymphadenitis)

서지정보

· 발행기관 : 대한내과학회
· 수록지 정보 : 대한내과학회지 / 93권 / 5호 / 477 ~ 481페이지
· 저자명 : 김진영, 김호연, 이형경, 정민선, 형례창, 김도훈, 정훈용

초록

결핵의 식도 침범 및 이의 합병증인 식도종격동누공 형성은 매우 드물고 국내 보고가 거의 없다. 대부분 종격동 림프절염에서 식도 침범이 이루어지고 이러한 경우 식도종격동누공을 형성할 수 있다. 저자들은 식도종격동누공 치료에 내시경적 클립 결찰술을 먼저 시도하였으나 누공 폐쇄에 실패하였고, 경피적 내시경 위루술을 통한 항결핵제 치료만으로 누공 폐쇄를 경험하였기에 보고한다.

영어초록

Tuberculosis rarely involves the esophagus, and most esophageal tuberculosis occurs secondary to adjacent tuberculous lymphadenitis. An esophago-mediastinal fistula is a very unusual complication of tuberculous lymphadenitis. Herein, we report a case of an esophago-mediastinal fistula due to tuberculous lymphadenitis. A 28-year-old woman who had dysphagia was assessed by chest computed tomography, endoscopy, esophagogram, and a lymph node biopsy. An esophago-mediastinal fistula was found and an antituberculous agent was considered initially. However, because of her severe dysphagia, she managed with endoscopic clipping as an alternative. However, the fistula remained on follow-up esophagography. A gastrostomy was eventually performed, and she was treated with an antituberculous agent. The fistula had closed after 4 weeks of medication. Antituberculous agents are the mainstay treatment for esophago-mediastinal fistula due to tuberculous lymphadenitis; endoscopic clipping may be a complementary treatment.

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