An unusual cause of desquamative esophageal lesions

The intussusception secondary to an unusual cause is a rare abdominal emergency posposing a diagnostic and therapeutic problem.We report a patient aged 23 who ingested two sips of spirit of salt as part of a suicide attempt. An upper gastrointestinal endoscopy showed a stage IIb esophageal and gastric lesion. A month later the patient presented with dysphagia for solids for which he received a feeding jejunostomy. The evolution was marked by the installation of a double intussusception of jejunostomy tube requiring surgery with no complications. Improving the management and prognosis of IIA secondary to an unusual cause requires an early diagnosis. The reduction of this particular form of intussusception is almost exclusively surgical.

An Extremely Rare Cause of Dysphagia

The following case describes a 29-year-old previously well gentleman who presented with an acute onset of chest pain, dysphagia, odynophagia and vomiting without haematemesis. An oesophageal lesion was visualised on...

An unusual cause of dysphagia in a young woman: esophageal duplication cyst

Esophageal Dieulafoy lesion: an unusual cause of GI bleeding

Purpose: Although the most common cause of upper gastrointestinal (UGI) bleeding in cirrhotic patients is related to complications of portal hypertension, all cases may not be variceal in nature. We are presenting here an unusual cause of esophageal bleeding in a patient with prior history of cirrhosis and variceal bleeding. Case: A 53 year old male patient with underlying alcoholic cirrhosis presented with 1 day history of hematemesis and melena. Vitals on presentation were: blood pressure 143/84, pulse of 142. Physical examination was remarkable for peripheral stigmata of alcoholic liver disease and ascites. Early endoscopic examination revealed grade I non bleeding esophageal varices and a mucosal defect/prominence seen in the distal esophagus. Gastric examination revealed moderate portal hypertensive gastropathy. On withdrawal of the endoscope active arterial spurting was seen in the distal esophagus (at the site of the mucosal defect). Injection treatment and electrocautery were used to slow down the rate of bleeding, but complete hemostasis could not be achieved. The patient underwent exploratory laprotomy and intra operative esophagogastroduodenoscopy, which confirmed the diagnosis of esophageal Dieulafoy's lesion as the cause of bleeding. Oversewing of the esophageal vessel and ligation of the first branch of the left gastric artery was performed, which resulted in hemostasis of this arterial lesion. Discussion: Dieulafoy's lesion is a rare arterial malformation that can cause massive GI hemorrhage. The lesion occurs most commonly in the proximal stomach. The esophagus is not a common location for this lesion. While evaluating cirrhotic patient's with UGI bleeding physicians must consider other sources like mallory weiss, peptic ulcer disease and Dieulafoy's lesion. Endoscopic diagnosis of Dieulafoy's lesion can be difficult because of the small size and obscure location of the lesion. Awareness of the condition and early correct diagnosis are extremely important for good outcomes. The treatment may require multi modality approach including timely surgical intervention.