Esophageal perforation in Zollinger-Ellison syndrome and the importance of assessing for aorto-gastric fistula: a report of two rare cases
Bibliographic record
Abstract
Background: Zollinger-Ellison syndrome (ZES) refers to the clinical manifestations of a gastrinoma, a neuroendocrine tumor causing hypersecretion of gastric acid. Symptoms include gastroesophageal reflux disease (GERD), recurrent peptic ulcers, and chronic diarrhea. Herein, we present two cases of esophageal perforation in patients with ZES, an exceedingly rare complication of this disease. Case Description: The first patient, a 49-year-old female with a history of esophagitis, duodenitis, and recurrent gastrointestinal (GI) bleeds, presented to the emergency department (ED) with nausea, vomiting and abdominal pain. Imaging demonstrated an esophageal perforation. She subsequently underwent repair with an intercostal muscle flap. Her post-operative course was complicated by a leak, which was managed with a stent. Unfortunately, the patient died from an aorto-gastric fistula. ZES was diagnosed on autopsy, which revealed a gastrinoma in the duodenal bulb. The second patient was a 48-year-old female known to have multiple endocrine neoplasia type 1 (MEN1). She had previously undergone a distal pancreatectomy for gastrinoma. This patient presented acutely with pleuritic chest pain. A chest X-ray (CXR) showed hydropneumothorax. When blood was expressed following chest tube insertion, a computed tomography angiogram (CTA) was used to assess for aorto-esophageal or -gastric fistula. Fortunately, no fistula was identified, and she subsequently underwent an uncomplicated esophageal repair with serratus flap. Following repair, they developed an esophageal stricture at the site of repair and remained J-tube dependent. Esophagectomy with colonic interposition was later performed. Conclusions: There are few documented cases of esophageal perforation in patients with ZES. Though an aorto-gastric fistula is a very rare complication of ZES, these cases highlight the importance of its consideration in the management of this patient population.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".