Benign esophageal stricture.A 75-year-old man who developed a peptic stricture of the lower esophagus after a prolonged period of bed rest and tube feeding (recovering from a head injury). The stricture was difficult to dilate and a perforation ensued. This was treated conservatively. The stricture progressed to the extent that the patient was unable to swallow his own saliva and further dilatation was undertaken. This was done under direct vision with a balloon dilator. A further perforation occurred. The patient underwent resection of the stricture and esophago-gastric reconstruction and formation of a 360 degree fundoplication in the chest.
The photograph shows the resected section of esophagus, with a grossly thickened and narrowed section about 5 cm above the cardia. The arrow points to the site of perforation - which is immediately above the stricture. Most strictures respond well to acid suppression and dilatation, and most endoscopic perforations can be managed conservatively. Every now and again, surgical intervention is required. The only practical surgical approach is resection of the strictured segment.
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