A Case of Epidermalysis Bullosa with Esophageal Obstruction Treated with Endoscopic Balloning

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  • 内視鏡的治療が有効であった食道入口部膜様閉塞を伴う表皮水疱症の1例
  • 症例 内視鏡的治療が有効であった食道入口部膜様閉塞を伴う表皮水疱症の1例
  • ショウレイ ナイシキョウテキ チリョウ ガ ユウコウ デ アッタ ショクドウ ニュウコウブマク ヨウ ヘイソク オ トモナウ ヒョウヒ スイホウショウ ノ 1レイ

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Abstract

A 61-year-old woman who had been diagnosed with congenital epidermalysis bullosa was seen at the department of oral surgery in our hospital because of pain of the right mandibular gingiva which started in around September 2012. Gingival cancer of the mandible was diagnosed. In December 2012, removal of the tumor and associated resection of the mandibular bone were performed when a gastric tube was impossible to insert. We attempted postoperative endoscopy but we could not insert the endoscope through the entrance part of the esophagus. Observation of the obstructed portion from a gastric fistula created for enteral nutrition as well as from the oral cavity disclosed membranous obstruction at the entrance part of the esophagus. A guide wire was perforated from the gastric fistula in a retrograde manner to perform balloon dilatation, then the dilatation was done up to 18 mm in diameter. After confirmed that no re-obstruction occurred, we completed the treatment.<BR>Epidermalysis bullosa is an incurable disease certified by the Ministry of Health, Labor and Welfare. People with the disease have blisters in the skin of the whole body since they were born. These blisters can affect the oral and esophageal mucosal membranes and some people can experience dysphagia caused by cicatrical stricture. We present this case of epidermalysis bullosa with esophageal obstruction which might be caused by intraoperative mechanical stimuli and postoperative long-term fasting, for which endoscopic ballooning was useful, together with a review of the literature.

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