Concluded Case

Case of dyphagia

48/F presenting with 3 years h/o dysphagia to solids >> liquids without any h/o regurgitation, chest pain, weight loss H/o dilatation 1 year back but again symptomatic since 2 months History Prior h/o ? corrosive ingestion 25 years back Investigations H/o EGD 1 year back, found to have cricopharyngeal narrowing beyond which scope could not be passed and dilated upto 9 mm. Present barium swallow attached. Management What is the diagnosis and what should be the management?

(Edited)

LikeAnswersShare
Concluded answer

A stricture presenting 22 years after intake of corrosive is unlikely to be post-corrosive stricture. There are two sites of narrowing. The upper one appears smooth while the lower stricture shows shouldering with irregular margin. Pediatric endoscope was passed across both the narrowing. The upper stricture was smooth walled while the lower one appeared malignant. CECT Thorax was done which was s/o concentric thickening of mid esophagus. RT insertion was done and biopsy was taken and patient was asked to follow up with biopsy report to plan for surgery

All Answers

A stricture presenting 22 years after intake of corrosive is unlikely to be post-corrosive stricture. There are two sites of narrowing. The upper one appears smooth while the lower stricture shows shouldering with irregular margin. Pediatric endoscope was passed across both the narrowing. The upper stricture was smooth walled while the lower one appeared malignant. CECT Thorax was done which was s/o concentric thickening of mid esophagus. RT insertion was done and biopsy was taken and patient was asked to follow up with biopsy report to plan for surgery

Since history is of 3 years - unlikely to be a malignant stricture . Most likely it is a benign corrosive stricture Treatment options 1.Regular balloon Dilatations 2 Stents 3.Surgery is the last resort

Benign corrosive structures If conservative management fails the best option would be surgery Mobilise the stomach with preservation of rt gastric and rt gastroepiploic vessels and anastomosis to the cervical oesophagus in the neck. The stomach can be placed in a tunnel created retrosternally. It can also be placed subcutaneously in front of the sternum

Pt is having corrosive stricture oesophagus proximal third of oesophagus and small stricture at the junction of lmiddle third and lower third. Bougie dilatation done one year back with recurrence and dilatation could not be done beyond 9 mm. Repeated dilatation has got number of complications. This pt may be suitable case for ante sternal colonic bye pass .

Smooth but mid oesophagus ? Corrosive poisoning stricture

Chances of malignancy in corrosive structure is pretty & hence early reconstructive surgery is always advisable.

Diseases Related to Discussion