Presentation
Vomiting, and weight loss. Parent and family are not sure about caustic ingestion.
Patient Data
This is an upper GI fluoroscopic study.
The esophagus is opacified with the contrast showing long segment irregular stricture involving the distal part of the esophagus with proximal esophageal dilatation.
Normal passage of contrast through the pylorus into the duodenum is noted.
The duodenum and parts of the jejunum along with duodenojejunal junction is noted on the right side consistent with the incidental finding of intestinal malrotation.
Case Discussion
The differential diagnosis for lower esophageal strictures is Barret's esophagus, scleroderma, and strictures secondary to neoplastic growths, all of which are less likely in children.
The first treatment option for esophageal strictures is balloon dilatation. Surgery is reserved for cases where balloon dilatation is unsuccessful.
Since the length of the stricture is relatively large in this particular patient and there is a possible risk of esophageal perforation, surgery rather than balloon dilatation was considered.