There are diverse ring-like narrowings in the lower esophagus: mucosal ring, muscular ring, ring-like annular peptic stricture. Esophageal muscular ring is extremely rare and generally asymptomatic. It occurs at the proximal border of the esophageal vestibule that corresponds to the upper end of the lower esophageal sphincter. We experienced a case of lower esophageal muscular ring with a symptom of intermittent mild dysphagia for 40 years and report the findings with a review of the literature.
Aged ; Deglutition Disorders/*etiology ; Esophageal Stenosis/complications/*diagnosis ; *Esophagogastric Junction ; Humans ; Male

OBJECTIVECongenital esophageal stenosis owing to tracheobronchial remnants (TBR) is a rare condition. This study was conducted to understand the clinical features of TBR.

METHODThe data of the four cases with TBR admitted to our hospital and 76 patients identified from the literature were reviewed. The clinical manifestation, X-ray, endoscopy, biopsy and treatment were studied retrospectively.

RESULTOf the total of 80 cases, 45 were male, 33 were female, and for 2 cases the gender was unknown. Symptoms of dysphagia and regurgitation developed at the age of 1-day to 12-month. Definitive treatment was carried out at the age of 1-month to 16-year. Twenty-seven patients had associated anomalies with esophageal atresia being the most prevalent. X-ray esophagography showed segmental stenosis at the distal third of the esophagus in all patients except three. An abrupt narrow segment at the lower esophagus with marked proximal dilatation was found in 32 cases. Esophagography of 12 cases showed distal esophageal stenosis with tapered narrowing. Esophagography of 20 cases showed flask-shaped shadow of distal esophageal stenosis and one patient showed linear projection of barium at the level of stenosis. Endoscopy found almost complete obstruction of the lower esophageal lumen without signs of the esophagitis or reflux. Esophagoscopic dilatation of the stenosis was attempted in 24 cases, but was ineffective, and 3 patients suffered esophageal perforation. Seventy-nine patients underwent resection of the stenotic segment. Histologic examination of the resected specimen showed cartilage, mucus glands, resembling bronchal tissue. Post-operative complication included anastomotic stenosis, anastomotic leakage, hiatal hernia, and gastroesophageal reflux.

CONCLUSIONTBR should be suspected in patients who present with a typical history of dysphagia after ingestion of solid food. Esophagography and esophagoscopy are the essential means for diagnosis. TBR should be different from achalasia and should be diagnosed by biopsy. Operation is the only choice of treatment.

Anastomosis, Surgical ; Barium Sulfate ; Biopsy ; Child, Preschool ; Choristoma ; complications ; Dilatation ; Esophageal Atresia ; complications ; Esophageal Perforation ; etiology ; Esophageal Stenosis ; congenital ; diagnosis ; pathology ; surgery ; Esophagoscopy ; Female ; Follow-Up Studies ; Humans ; Infant ; Male ; Postoperative Complications ; epidemiology ; Retrospective Studies ; Tracheoesophageal Fistula ; etiology

PURPOSE: Congenital esophageal atresia (CES) is a rare congenital disease. The severity of symptoms is variable; thus, diagnosis is difficult and tends to be delayed. CES is frequently accompanied by esophageal atresia (EA) with/without tracheoesophageal fistula (TEF). We investigated the characteristics of CES by reviewing our experience with CES patients and researched the differences between CES with EA-TEF and isolated CES. METHODS: A total of 31 patients underwent operations for CES were reviewed retrospectively. The patients were divided into two groups according to the association with EA-TEF, and compared the differences. RESULTS: Sixteen boys and 15 girls were included. The mean age at symptom onset was 8 months old, and the mean age at diagnosis was 21 months old. Nine patients with EA-TEF were included group A, whereas the other 22 patients were assigned to group B. There were no differences in sex, gestational age, associated anomalies and pathologic results between the groups. In group A, the age at diagnosis and age at surgery were younger than in group B despite the age at symptom occurrence being similar. Postoperative complications occurred only in group A. CONCLUSION: In this study, symptoms occurred during the weaning period, and vomiting was the most frequent symptom. CES patients with EA-TEF tended to be diagnosed and treated earlier despite the age at symptom occurrence being similar. CES patients with EA-TEF had more postoperative complications; therefore, greater attention should be paid during the postoperative period.
Child ; Clinical Study* ; Diagnosis ; Esophageal Atresia* ; Esophageal Stenosis* ; Female ; Gestational Age ; Humans ; Postoperative Complications ; Postoperative Period ; Retrospective Studies ; Tracheoesophageal Fistula* ; Vomiting ; Weaning

OBJECTIVETo explore the treatment of cervical tracheoesophageal fistula (TEF) with complicated or remnant laryngotracheal stenosis (LTS) and anterior neck defect (AND).

METHODSFrom 1980 to 2007, 14 patients were diagnosed as TEF. Among them, 9 patients had complicated or remnant LTS, 3 patients had complicated AND, and 2 patients had TEF which were induced by Nickel-Titanium alloy mesh stent for treating benign esophageal stricture. All these patients were retrospectively studied in Tangdu Hospital. Treatment consisted of conservative therapy of TEF, staged surgical repair of TEF and laryngotracheal reconstruction according to the dimension (small or large) of TEF and complications.

RESULTSFour patients with small TEF (2 - 3 mm length) complicated LTS underwent laryngotracheal reconstruction stented with silicone T tube and TEF was adopted conservative treatment. The TEF and LTS were healed. Six patients with larger TEF (10 - 25 mm length) were repaired by staged surgical repair of TEF and laryngotracheal reconstruction. Among them, 3 cases had complicated LTS and AND, 2 cases had recent LTS and 1 case had TEF without complication. Two patients had TEF and LTS, whose TEF healed before laryngotracheal reconstruction, the remnant LTS were reconstructed and healed. During the follow-up ranged from one to ten years, 12 patients were successfully treated without complications. One patient with TEF and LTS was treated only LTS because of a segment of esophagus was closed and treated with esophagogastrostomy in the department of thoracic surgery after LTS was successfully reconstructed and cured. One patient died of bleeding and asphyxia induced by the Nickel-Titanium alloy stent because of the stent had not been taken out.

CONCLUSIONThe small cervical TEF complicated or remnant LTS can be treated by laryngotracheal reconstruction and conservative treatment of TEF at the same time. A larger TEF complicated LTS should be treated by staged repair of TEF and LTS.

Adolescent ; Adult ; Child ; Child, Preschool ; Cutaneous Fistula ; complications ; diagnosis ; surgery ; Esophageal Stenosis ; complications ; diagnosis ; surgery ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Tracheoesophageal Fistula ; complications ; diagnosis ; surgery ; Treatment Outcome ; Young Adult

Ankylosing spondylitis (AS) is a chronic inflammatory rheumatological disease affecting the axial skeleton with various extra-articular complications. Dysphagia due to a giant anterior osteophyte of the cervical spine in AS is extremely rare. We present a 48-year-old male with AS suffering from progressive dysphagia to soft foods and liquids. Esophagography showed an anterior osteophyte at C5-C6 resulting in esophageal compression. The patient refused surgical resection of the osteophyte and received conservative therapy. However, after 6 months there was no improvement in dysphagia. This case illustrates that a large cervical osteophyte may be the cause of dysphagia in patients with AS and should be included in the diagnostic workup in early stages of the disease.
Cervical Vertebrae/*pathology/radiography ; Deglutition ; Deglutition Disorders/diagnosis/*etiology/physiopathology/therapy ; Esophageal Stenosis/diagnosis/*etiology/physiopathology/therapy ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Osteophyte/diagnosis/*etiology/therapy ; Spondylitis, Ankylosing/*complications/diagnosis/therapy ; Tomography, X-Ray Computed ; Treatment Outcome

Eosinophilic esophagitis (EoE) is a chronic, immune/antigen-mediated esophageal disease affecting both children and adults. The condition is characterized by an eosinophilic infiltration of the esophageal epithelium. Symptoms of esophageal dysfunction include dysphagia, food impaction and symptoms mimicking gastroesophageal reflux disease. Endoscopic examination typically reveals mucosal fragility, ring or corrugated mucosa, longitudinal furrows, whitish plaques or a small caliber esophagus. Histologic findings of >15 eosinophils per high-power field is the diagnostic hallmark of EoE. An elimination diet, topical corticosteroids or endoscopic dilation for fibrostenotic disease serve as effective therapeutic option.
Administration, Topical ; Adrenal Cortex Hormones/*therapeutic use ; Adult ; Child ; Deglutition Disorders/etiology ; Diagnosis, Differential ; Eosinophilic Esophagitis/complications/diagnosis/*therapy ; Esophageal Stenosis/etiology/*surgery ; Esophagoscopy ; Esophagus/*pathology ; *Food Habits ; Gastroesophageal Reflux/diagnosis ; Humans

PURPOSE: Congenital esophageal stenosis(CES) is one of the rare causes of recurrent vomiting during infancy and childhood. We studied the diagnostic and therapeutic tools and postoperative complications for early diagnosis and adequate management of CES. METHODS: Fourteen cases of CES were evaluated for clinical manifestations, findings of esophagogram and esophagoscopy, classification of pathologic findings and postoperative complications. RESULTS: Most common clinical manifestations at onset were non-projectile vomiting(14), dysphagia to solids(13). Age at onset of symptoms corresponded with the introduction of solids in 11 cases. Esophagogram showed segmental stenosis of variable length in the lower portion of the esophagus in all cases with marked proximal dilatation in 11 cases. Esophagoscopy revealed no signs of esophagitis or ulcer at the area of stenosis. Segmental resection and primary anastomosis were performed as a definitive treatment modality in all cases except one with fibromuscular stenosis. Bronchial cartilage were present in all cases of tracheobronchial remnants(10). Abnormal arrangement and thickening of muscularis mucosae and inner circular muscle were found in all cases of fibromuscular stenosis(4). Postoperative complications were gastroesophageal reflux(5), stricture of anastomotic sites, reflux esophagitis, and so on. CONCLUSION: CES is rare but should be considered as a cause of recurrent vomiting and dysphagia to solid food beginning in infancy and childhood especially in the weaning period. Esophagogram and esophagoscopy are useful tools for diagnosis and differential diagnosis. The stricture of anastomosis site, gastroesophageal reflux and esophagitis need to be evaluated in the follow-up postoperative periods.
Cartilage ; Classification ; Constriction, Pathologic ; Deglutition Disorders ; Diagnosis* ; Diagnosis, Differential ; Dilatation ; Early Diagnosis ; Esophageal Stenosis* ; Esophagitis ; Esophagitis, Peptic ; Esophagoscopy ; Esophagus ; Follow-Up Studies ; Gastroesophageal Reflux ; Mucous Membrane ; Postoperative Complications* ; Postoperative Period ; Ulcer ; Vomiting ; Weaning

PURPOSE: Congenital esophageal stenosis (CES) is a rare cause of esophageal narrowing due to intrinsic esophageal wall abnormalities such as tracheobronchial remnants (TBR), web, and fibromuscular dysplasia (FMD). It is sometimes associated with esophageal artesia (EA). METHODS: The medical records of children, who underwent operation due to CES at the Asan Medical Center from Jan 1990 to Dec 2007, were retrospectively reviewed. RESULTS: Among 12 patients (M : F=6 : 6), 9 patients had TBR and 3 had FMD. The median age of operation was 25 months (7 mo~6 years). Four patients underwent operation for esophageal atresia at neonate, one underwent operation for duodenal atresia and one for ventricular septal defect. Recurrent vomiting or dysphagia was developed at weaning period or introduction of solid foods. The lesions of stenosis were low-esophagus in 11 and mid-esophagus in 1. Segmental resection of lesion and end-to-end anastomosis of esophagus were completed successfully by means of laparotomy in 9 and thoracotomy in 3 (left in 1, right in 2). One patient treated with ballooning at first, suffered from mediastinitis due to esophageal perforation. Postoperative complications were anastomosis leakage in 2 and lung abscess in 1. Esophageal ballooning for anastomosis stricture was performed in 2 patients and an esophageal stent was needed in 1 patient. All patients are relieved from dysphagia and able to eat solid food. CONCLUSION: CES is rare but should be considered for recurrent vomiting and dysphagia, especially for those who underwent operation for EA. Differential diagnosis from other causes such as gastro-esophageal reflux is essential and surgical treatment is treatment of choice.
Child ; Constriction, Pathologic ; Deglutition Disorders ; Diagnosis, Differential ; Duodenal Obstruction ; Esophageal Atresia ; Esophageal Perforation ; Esophageal Stenosis ; Esophagus ; Fibromuscular Dysplasia ; Gastroesophageal Reflux ; Heart Septal Defects, Ventricular ; Humans ; Infant, Newborn ; Laparotomy ; Lung Abscess ; Mediastinitis ; Medical Records ; Postoperative Complications ; Retrospective Studies ; Stents ; Thoracotomy ; Vomiting ; Weaning

Giant hiatal hernia (GHH) comprises 5% of hiatal hernia and is associated with significant complications. The traditional operative procedure, no matter transthoracic or transabdomen repair of giant hiatal hernia, is characteristic of more invasion and more complications. Although laparoscopic repair as a minimally invasive surgery is accepted, a part of patients can not tolerate pneumoperitoneum because of combination with cardiopulmonary diseases or severe posterior mediastinal and neck emphesema during operation. The aim of this article was to analyze our experience in gasless laparoscopic repair with abdominal wall lifting to treat the giant hiatal hernia. We performed a retrospective review of patients undergoing gasless laparoscopic repair of GHH with abdominal wall lifting from 2012 to 2015 at our institution. The GHH was defined as greater than one-third of the stomach in the chest. Gasless laparoscopic repair of GHH with abdominal wall lifting was attempted in 27 patients. Mean age was 67 years. The results showed that there were no conversions to open surgery and no intraoperative deaths. The mean duration of operation was 100 min (range: 90-130 min). One-side pleura was injured in 4 cases (14.8%). The mean postoperative length of stay was 4 days (range: 3-7 days). Median follow- up was 26 months (range: 6-38 months). Transient dysphagia for solid food occurred in three patients (11.1%), and this symptom disappeared within three months. There was one patient with recurrent hiatal hernia who was reoperated on. Two patients still complained of heartburn three months after surgery. Neither reoperation nor endoscopic treatment due to signs of postoperative esophageal stenosis was required in any patient. Totally, satisfactory outcome was reported in 88.9% patients. It was concluded that the gasless laparoscopic approach with abdominal wall lifting to the repair of GHH is feasible, safe, and effective for the patients who cannot tolerate the pneumoperitoneum.
Abdominal Wall ; surgery ; Aged ; Esophageal Stenosis ; etiology ; Female ; Fundoplication ; adverse effects ; methods ; Heartburn ; etiology ; Hernia, Hiatal ; diagnosis ; surgery ; Humans ; Laparoscopy ; adverse effects ; methods ; Male ; Middle Aged ; Pneumoperitoneum, Artificial ; adverse effects ; Postoperative Complications