An unusual cause of dysphagia

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Dtsch Med Wochenschr. 2004 May 7;129(19):1065-8. Related Articles, Links

 

[An unusual cause of dysphagia]

[Article in German]

Lebiedz P, Domschke W, Pohle T.

Medizinische Klinik und Poliklinik B, Universitatsklinikum Munster.

HISTORY AND ADMISSION FINDINGS: We report the case of a 79-year old male

patient with progressive dysphagia 9 years after resection of an

adenocarcinoma of the esophagus. The patient presented with cachexia and a

weight loss of 10 kg within the last 10 weeks. He was unable to swallow

solids and liquids. 6 weeks before he had suffered from pneumonia caused by

aspiration. Two previously performed gastroscopic examinations had

documented a stenosis of the anastomosis which was passed by the endoscope.

Tissue specimens taken from the stenosis showed high-grade dysplasia.

INVESTIGATIONS: Computed tomography of the thorax documented a stenosis of

the esophagus with prestenotic dilatation and intraluminal food. There were

no signs indicating local recurrence of the tumor such as transmural

lesions. DIAGNOSIS, TREATMENT AND COURSE: Endoscopic examination showed an

impacted foreign body measuring 2 x 4 cm which was be extracted.

Extracorporeal inspection of this foreign body revealed it to be a dried

apricot. After retaking the history, the patient was able to date the time

of ingestion to have been three months earlier, shortly before his dysphagia

had started. After extraction of the foreign body dysphagia resolved and the

patient gained weight. CONCLUSION: Ingestion of foreign bodies or a food

bolus may occur unnoticed on rare occasions and even large ones may remain

undiagnosed despite repeated endoscopic examinations.

PMID: 15136951 [PubMed - in process]