J.Jpn. Surg. Soc.. 82(5): 498-504, 1981
Original article
ESOPHAGEAL STRICTURE DUE TO SYSTEMIC LUPUS ERYTHEMATOSUS (SLE):A Case Report
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First Department of Surgery, Tokyo Medical and Dental University, School of Medicine K. Sugihara, K. Ishi, H. Terajima, R. Hatano, M. Menjo |
A 38-year-old-male with a known history of SLE for 6 years presented with sever difficulty of swallowing which was found to be due to concentric stricture of the lower esophagus (Ei) but biopsy was negative for malignancy. Upper GI series showed funnel-shaped dilatation of the esophagus above the stricture and abnormally dilated duodenum and proximal jejunum. The esophagus was removed by means of blunt dissection and stripping and it was reconstructed by a use of proximal jejunum at the neck via retrosternal route after full-length sternotomy with resection of manubrium sterni. Upon termination of the operation, severe Raynaud phenomenon appeared at all the extremities, which was treated with papaverine hydrochloride, dexamethazone and phenoxybenzamine. Various stimuli such as pain and endotracheal suctioning provoked Raynaud phenomenon, postoperatively. On 5th postoperative day, the right femoral artery thrombosis appeared and Fogarty throbectomy was performed but on 26th POD, above-the-knee amputation was performed. Histologic examination showed chronic ulcer (U1-4) of the lower esophagus close to G-Ejunction. Chronic inflammatory changes were dominant feature but vascular changes were full of varieties such as granulomatous obstruction of the arterioles and "onion skin" lesions. These vascular changes were not able to be determined whether this is characteristic with SLE or merely a secondary phenomenon to chronic ulcer. Esophageal manifestation of SLE is a rare occurrence and this report appears to be fifth case in Japan and second case of excision and reconstruction. Severe Raynaud phenomenon is essentially rare in SLE but it should be borne in mind that it may be provoked by subtle stimuli and may become a critical problem in postoperative period.
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