Plummer-Vinson综合征内镜检查

Plummer-Vinson Syndrome
associated with Mutilans Rheumatoid Arthritis

The gastric cardia seen from an retrogade endoscopy from the hole of surgical gastrostomy performed 16 years previous, The gastrostomy tube is removed. A standard endoscope is passed retrograde to the upper esophageal sphinter.

This is the case of a 65 year-old female who had suffered from a mutilans rheumatoid arthritis since 19. She had difficulty to swallow, and therefore she had not been tasting flavors well during 16 years. She arrived for a second opinion, and on two different clinics they didn′t do an endoscopy becasue of Temporomandibular joint involvement. The only treatment they did was to place a gastrostomy tube to feed her.

Deformity of both hands is observed, the patient had suffered from 19 years of this rheumatoid arthritis,
There destruction of finger bones, due to arthritis of the temporomandibular joint, do not open her jaw, and impossible to do an upper endoscopy, the patient could not wander, comes in a wheelchair, there are deformation on feet, and two previous surgeries were placed prosthetic knees.

For the therapeutic management, we took a conservative approach because of her status and oxygen saturation. However we had intended to try an aggressive plan, like using a hydrostatic dilator and combine it with argon plasma.

Also, because of her arthritis, her temporo-mandibular joint is compromised so the endoscopy was not able to be done properly, so we were planning on doing it through the nasal airways.

                               
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The endoscopy was finally done via a gastrostomy fistula. When getting to the superior esophageal sphincter, the inferior part was surrounded with a membrane.