Pneumatosis intestinalis and mesenteric venous gas - a manifestation of bacterascites in a patient with cirrhosis.

We herein report a patient with decompensated cirrhosis secondary to autoimmune hepatitis, who presented with pneumatosis intestinalis (PI) and portal venous gas. Mesenteric ischemia has been recognized as a common and life-threatening cause of PI which portends a grave prognosis. The patient was found to have bacterascites and recovered after appropriate antibiotic therapy. Spontaneous bacterial peritonitis/bacterascites with gas-forming organisms manifesting as PI has not been previously reported.

Endoscopic occlusion of idiopathic benign esophago-bronchial fistula.

We report a 35-year-old male with recurrent respiratory infections and cough associated with ingestion of food for 15 years. He was diagnosed to have benign esophago-bronchial fistula and proximal jejunal stricture secondary to a tumor, which was surgically resected. In view of recent surgery, endoscopic closure of the fistula was attempted initially with an endoclip resulting in partial symptomatic relief. The fistula was later completely occluded endoscopically with cyanoacrylate glue. A barium swallow at eight-months follow-up revealed no evidence of esophago-bronchial communication. A high index of suspicion is required in the diagnosis of this rare entity in adults with recurrent respiratory infections of obscure etiology. Surgical resection is the standard treatment. Here we report a rare case of idiopathic benign esophago-bronchial fistula in an adult, treated with endoscopic approach.