Case report
Gastroesophageal intussusception: a new cause of acute esophageal obstruction in children

https://doi.org/10.1016/j.jpedsurg.2004.03.073Get rights and content

Abstract

Gastrointestinal intussusception with obstruction is common in the small bowel and colon; however, such a process is not known to cause esophageal obstruction. Recent experience with gastroesophageal intussusception permits discussion of diagnosis and consideration of treatment options. A 3-year-old child presented with acute esophageal obstruction. Physical examination was significant for epigastric tenderness and excessive salivation. Chest x-ray showed a posterior mediastinal fullness. Esophagram documented a smooth crescent-filling defect, which caused obstruction of the esophagus at the level of the carina with proximal esophageal dilatation. Chest computed tomography of the thorax showed a soft tissue mass of the distal esophagus. Esophagoscopy confirmed occlusion of the midesophagus with the mucosa intact. A right thoracotomy permitted visualization of dilated proximal esophagus and a palpation of an intraluminal mass in the distal esophagus. Mobilization of the distal esophagus and gentle manual pressure cleared the obstruction to a point below the diaphragm. After a normal intraoperative esophagram, final treatment consisted of a longitudinal esophagomyotomy. The child recovered without complication and continues without recurrence for 18 months. This is the first report of gastroesophageal intussusception in children. Management by thoracotomy, manual reduction, and esophageal myotomy reestablished intestinal continuity and appears to eliminate recurrence; fundoplication or gastropexy may be alternative options. Preoperative recognition of gastroesophageal intussusception may allow nonoperative reduction or treatment by minimally invasive surgery.

Section snippets

Case report

A 3-year-old African-American boy presented with acute onset of upper abdominal discomfort, regurgitation of food and excessive salivation. His past medical and surgical history were unremarkable, and he was otherwise healthy. His mother reported no prior history of similar events and stated that these symptoms occurred suddenly after an episode of retching several hours before his presentation. His physical examination was significant for epigastric tenderness and salivation. Chest x-ray

Discussion

A form of retrograde gastroesophageal intussusception was first described by Enderlin in Germany in an autopsy in 1903.1 The pathologic process in adults has been described as gastroesophageal prolapse, gastric mucosal prolapse, or prolapse, gastropathy syndrome.2, 3 In 1947, Wells4 reported that herniation of gastric mucosa in the esophagus can occur. After Wells’ report, several investigators described cases in adults who manifest sudden dysphagia and acute hemorrhage combined with

References (8)

  • E.G. Laforet

    Acute hemorrhagic incarceration of prolapsed gastric mucosa

    Gastroenterology

    (1976)
  • M. Enderlin

    Invagination der vorderen Magenwand in den Oesophagus

    Dtsch Z Chir

    (1903)
  • I. Buhac

    Gastric mucosal prolapse or gastroesophageal intussusception

    Dig Dis Sci

    (1985)
  • E. Thomas et al.

    Hemorrhage due to retrograde prolapse of stomach

    Am J Gastroenterol

    (1979)
There are more references available in the full text version of this article.

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