ATILLA ERTAN, MD, MACG, FACP

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• ATILLA ERTAN, MD, MACG, FACP

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• A 64 y/o male with mild and chronic GERD
  since childhood who had a progressive dysphagia
  episodes and 30-31 lbs weight loss since May 05.
  He was seen by various gastroenterologists who
  had four different EGDs with extensive biopsies
  and endoscopic dilatations x 4 for a
  short-segment and benign appearing stricture at
  32-33 cm from the incisors. Biopsies and imaging
  studies, including chest/abd CTs x 2 the
  esophageal EUS results were unremarkable. He was
  referred to TMH for further management plans on
  October 11 05.

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• MED Lansoprazole caps 30 mg BID
• PMH/PSH Unremarkable
• FH His brother had colon polyps.
• SH Married, ENT practitioner, smoked 1 pack/d
  for 40 yrs, drinks 2-3 hard liquors/d for 26 yrs.
• ROS Diminutive few adenomatous colon polyps
  removed in 02 diverticula coli.
• PE Essentially unremarkable.

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64 y/o male with progressive intermittent
dysphagia 1
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64 y/o male with progressive intermittent
dysphagia 2
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• A 40 y/o female with a h/o Takayasus
  arteritis who had multiple abdominal vessel graft
  operations, including an aorto-renal bypass in
  78 and bypass from her ascending aorta to
  infrarenal abdominal aorta in 91. She was
  admitted to a local hospital with a fever, severe
  and painless UGIB requiring over 30 units of
  PRBCs in 0105 who was managed conservatively
  and after the necessary paper work referred to
  TMH for further management plans in late April
  05.

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40 y/o female with Takayasus arteritis UGIB
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• AORTO-ENTERIC FISTULAS AEFs
• AEFs are rare, but very serious lesions
  responsible
• for significant GIB as seen in this case.
  Although
• these AEFs most commonly appear 3 to 5 years
• after the graft surgery, they may occur after
  many
• years of the repair. Two types are recognized
• Primary AEFs occur de novo between aorta and
  bowel, most commonly into the 3rd portion of the
  duodenum.
• Secondary types occur between a graft and a
  segment of the bowel. One of the major
  precipitating factor for AEFs is graft infection.
  The prognosis is poor if the diagnosis and
  reconstructive surgery have been delayed.
• Ann Vasc Surg, 14 668-696, 2000.
• Semin Vasc Surg, 14 302-311, 2001.

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• A 66 y/o female with a h/o NSAID associated GU in
  92 and chronic PPI dependent GERD for years
  who also has had a biopsy proven ulcerative
  ileitis and proctitis with mild to moderate
  clinical course since 93.
• Her IBD serology markers were all negative.
• Her second colonoscopy was performed on 03/22/04
  with an oral sodium phosphate bowel cleansing.