Patient Presentation

Findings Thoracic esophagus: stricture 3-4cm in length at the mid esophagus; no extra- luminal contrast extravasation is seen Small bowel follow-through: normal; no evidence of obstruction, stricture, or malrotation

Differential Diagnosis Esophagitis – viral, bacterial, caustic, chemical, thermal injury Stricture – caustic and pill induced, inflammatory (candidal, Crohn’s disease), post-operative, post- irradiation, congenital, tumor Disorder of esophageal smooth muscle (scleroderma, myopathy, achalasia) Numerous others – history very important

Lye 101 a 3 year old boy with suspected esophageal perforation after lye ingestion Lye: A strong caustic alkaline solution of potassium salts obtained by leaching wood ashes; used in making soaps A major component in modern drain and sewer openers – used to bleach, soften, scour, and dissolve adherent materials Ingestion leads to severe corrosive injury, causing perforation and scarring

Extensive necrosis of gastric wall with perforation. Winek et al. Forensic Science International 73 (1995) 146.

Management of Post-Injury Stricture Dilation (Hurst and Maloney, Tucker, Gruntzig balloon) followed by barium esophagograms If these methods fail, esophageal replacement is necessary – gastric pull-ups, colonic interpositioning

References Kasper et al. Harrison’s Principles of Internal Medicine. 16 th ed. McGraw-Hill, Gay and Woodcock. Radiology Recall. Lippincott Williams and Wilkins, Baltimore, Winek et al. Ingestion of Lye. Forensic Science International 1995;73(2):143-7.