History of chronic vomiting, regurgitation, aspiration pneumonia and suspected megaesophagus or swallowing deficits. Physical exam: very underweight
History of chronic vomiting, regurgitation, aspiration pneumonia and suspected megaesophagus or swallowing deficits. Physical exam: very underweight
Barium Swallow Fluoroscopy: The cervical, cranial thoracic and mid thoracic esophagus presented severe segmental dilatation. Cranial to the diaphragm constrictive narrowing of the caudal thoracic esophagus was noted. Vigorous secondary peristaltic waves were not able to empty the dilated esophagus beyond the stenosis as the narrowing persisted throughout all phases of swallowing/peristalsis. Only scant amounts of the barium soaked meal were able to pass the stenosis and enter the stomach. The secondary peristaltic waves appeared to descend the length of the esophagus incompletely.
The cause of the stenosis may be mechanical, such as a stricture, or functional, such as lower esophageal sphincter achalasia or asynchrony, either.
Potential causes of stricture include traumatic, such as foreign bodies or chemical irritation, and congenital. Esophageal dysmotility disorders overall are lower for potential as the position of the obstruction cranial to the diaphragm does not match the regular anatomy.
The generalized esophageal dysmotility likely is a late sequela to the chronic dilation and may be irreversible. The prognosis is guarded.
Endoscopy was recommended to plan therapeutic approach such as interventional balloon dilation or surgery.
megaesophagus or swallowing deficits
