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CLINICAL PRESENTATION
A 41-year-old man was diagnosed with gastro-oesophageal reflux disease (GORD) in 1993 when he took part in a clinical study. He was on H2 receptor antagonists and then proton-pump inhibitors until he was referred to the surgical clinic in 2001 for worsening reflux symptoms.
An upper gastrointestinal endoscopy was performed, which showed a large sliding hiatus hernia, a Barrett’s mucosa 3 cm in length, and distal gastritis. Oesophageal pH studies and manometry showed marked reflux disease and impaired motility in the distal oesophagus. A preoperative barium swallow showed a sliding hiatus hernia, considerable oesophageal reflux and erosions in the stomach.
The patient underwent trans-abdominal Lind fundoplication in 2003. He was discharged from the clinic after a full recovery. Eleven months after his surgery, he presented with recurrent severe reflux symptoms. He had a gastroendoscopy and a barium meal (figure 1).
QUESTION
What is the diagnosis?
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Acknowledgments
This article has been adapted from Alzaraa A, Kelty C, Jacob G, White D, Jacob G. Oesophagogastric fistula: a post-operative complication Gut 2007;56:1225