A Malignant Connection: Bronchoesophageal-Pleural Fistula in an Elderly Farmer.

Bronchoesophageal-pleural fistula (BEPF) is a very rare entity that can present as a late manifestation of oesophageal malignancy. Here, we describe the case of an elderly farmer with no past medical history of note who presented with acute respiratory failure associated with a five-month history of dysphagia and weight loss. Computerised tomography of the thorax showed a connection between the oesophagus, bronchus and pleural space: a bronchoesophageal-pleural fistula. Ultrasound-guided thoracentesis was followed by chest drain insertion into an empyema containing food debris. Histopathological analysis of endoscopic biopsies confirmed an eroding squamous cell carcinoma (SCC) of the oesophagus. An oesophageal stent was inserted to seal off the fistula and broad-spectrum antibiotics were maximised. Ultimately, after four weeks in hospital, palliative therapy was initiated. BEPF remains a very rare and devastating complication of oesophageal malignancy. Endoscopic stenting may provide symptomatic relief.

Irritable bowel syndrome: role of food in pathogenesis and management.

Patients with the irritable bowel syndrome (IBS) commonly report the precipitation of symptoms on food ingestion. Though the role of dietary constituents in IBS has not been extensively studied, food could contribute to symptom onset or even the causation of IBS through a number of mechanisms. First, the physiological response of the intestine to food ingestion could precipitate symptoms in predisposed individuals; second, there is some evidence that allergy or intolerance to a particular food can produce IBS-like symptoms, third, certain foods may alter the composition of the luminal milieu, either directly or indirectly through effects on bacterial metabolism, and thus induce symptoms and, finally, IBS may develop following exposure to food-borne pathogens. Anticipatory, psychological factors generated by previous negative experiences with food ingestion or other factors may also contribute though their contribution has been scarcely quantified. Not surprisingly, there is considerable interest in the potential roles of diet and food supplements in the therapy of IBS; for the most part, the evidence base for such recommendations remains slim though certain probiotics show considerable promise.

Penetrating ectopic peptic ulcer in the absence of Meckel's diverticulum ultimately presenting as small bowel obstruction.

We report here how a heterotopic penetrating peptic ulcer progressed to cause small bowel obstruction in a patient with multiple previous negative investigations. The clinical presentation, radiographic features and pathological findings of this case are described, along with the salient lessons learnt. The added value of wireless capsule endoscopy (WCE) in such circumstances is debated.