2023 Volume 65 Issue 1 Pages 29-35
An 85-year-old man was admitted due to cerebral hemorrhage. The next day, hematemesis developed with multiple deep-seated esophageal ulcers, confirmed by EGD. Suspecting esophageal perforation, we observed the patient till the upper thoracic esophagus. Chest computed tomography performed immediately after EGD revealed subcutaneous and mediastinal emphysemas. Thus, esophageal perforation was diagnosed. Emergency surgery involving esophagectomy, esophagostomy, and enterostomy was performed. The extracted specimens revealed extensive long-segment Barrettʼs esophagus (LSBE) as the underlying cause of the multiple esophageal ulcers. Moreover, the entire region was recognized to be malignant. However, the condition was classified as an acute, non-cancerous ulcer after determining that the cells had only invaded up to T1b-SM and muscle layer invasion of the cancer cells had not occurred in any ulcer base. On day 57 postoperatively, the esophagogastric junction (EGJ) was identified at 17 cm from the incisor, and the biopsy revealed remnants of Barrettʼs esophageal cancer. On day 77 postoperatively, gastrointestinal reconstruction (esophagogastrostomy) was performed for a thorough resection of remnant esophageal cancer. Considering the operations performed, Barrettʼs esophageal cancer was extremely extensive as it exceeded 18 cm. In this report, we have described an unusual case of pathological combination of extensive Barrettʼs esophageal cancer, with LSBE as the underlying etiology and multiple acute deep esophageal ulcers following a cerebral hemorrhage.
