Oesophageal bolus obstruction
Eating roast dinner (lamb) overnight. Meat now feels "stuck" in upper oesophagus. Unable to swallow Coke or water. Continuously vomiting. No previous symptoms.
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Localised food bolus with associated fluid level in the mid oesophagus at the level of the aortic arch. No other cause is evident. Oesophagus is collapsed and empty more distally.
Food bolus obstruction is usually due to underlying oesophageal pathology such as reflux stricture, carcinoma or mechanical stent for malignancy. Without underlying pathology the patient might be edentulous (i.e. unable to chew food adequately) or have impaired conscious state. In the past a barium study was the examination of choice but CT can now provide reasonable assessment prior to endoscopic removal. CT can also exclused perforation, i.e. the absence of extraluminal gas.