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Patient Presentation. Findings Thoracic esophagus: stricture 3-4cm in length at the mid esophagus; no extra- luminal contrast extravasation is seen.

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Presentation on theme: "Patient Presentation. Findings Thoracic esophagus: stricture 3-4cm in length at the mid esophagus; no extra- luminal contrast extravasation is seen."— Presentation transcript:

1 Patient Presentation

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4 Findings Thoracic esophagus: stricture 3-4cm in length at the mid esophagus; no extra- luminal contrast extravasation is seen Small bowel follow-through: normal; no evidence of obstruction, stricture, or malrotation

5 Differential Diagnosis Esophagitis – viral, bacterial, caustic, chemical, thermal injury Stricture – caustic and pill induced, inflammatory (candidal, Crohn’s disease), post-operative, post- irradiation, congenital, tumor Disorder of esophageal smooth muscle (scleroderma, myopathy, achalasia) Numerous others – history very important

6 Lye 101 a 3 year old boy with suspected esophageal perforation after lye ingestion Lye: A strong caustic alkaline solution of potassium salts obtained by leaching wood ashes; used in making soaps A major component in modern drain and sewer openers – used to bleach, soften, scour, and dissolve adherent materials Ingestion leads to severe corrosive injury, causing perforation and scarring

7 Extensive necrosis of gastric wall with perforation. Winek et al. Forensic Science International 73 (1995) 146.

8 Management of Post-Injury Stricture Dilation (Hurst and Maloney, Tucker, Gruntzig balloon) followed by barium esophagograms If these methods fail, esophageal replacement is necessary – gastric pull-ups, colonic interpositioning

9 References Kasper et al. Harrison’s Principles of Internal Medicine. 16 th ed. McGraw-Hill, Gay and Woodcock. Radiology Recall. Lippincott Williams and Wilkins, Baltimore, Winek et al. Ingestion of Lye. Forensic Science International 1995;73(2):143-7.


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