Double lumen esophagus: presentation of esophagogastric fistula, a rare complication of fundoplication.

A double lumen of the distal esophagus, a presentation of an esophagogastric fistula, was found in a patient who previously had an esophageal ulcer following a Nissen fundoplication. Only one other patient in our endoscopic experience of 24 years and 37,808 endoscopies has had this complication. Another patient was found to have an esophagogastric fistula, but it was associated with carcinoma. By contrast, in the 490 patients who had a Nissen fundoplication performed from 1960 to 1983, 23 (4.7%) developed an endoscopically proven esophageal ulcer. Therefore, although a double-lumen esophagus is a rare complication after a Nissen fundoplication, ulceration uncomplicated by an esophagogastric fistula is more common. Presenting symptoms of an esophagogastric fistula may be variable, but our patient, as well as two previous case reports, had dysphagia. The diagnosis is suggested radiologically and established endoscopically.