CASE OF A SEVERE AND LONG BENIGN STRICTURE OF THE ESOPHAGUS

Abstract

A unique case of a severe and long benign stricture of the esophagus was experienced by the authors. A 50‐year‐old alcoholic man was admitted to our hospital complaining of dysphagia as well as severe and continuous retrosternal burning pain of acute onset after abrupt vomiting. His previous medical history included alcoholic liver dysfunction, renal dysfunction, Klinefelter’s syndrome and a surgically treated duodenal ulcer. Ingestion of foreign body or acid/alkali substances was excluded. Although histopathologic examination of the endoscopic biopsy specimen was reported to be an esophageal squamous cell carcinoma, endoscopic findings and a barium esophagogram were not typical for a malignant disease. Since this study demonstrated a smooth surface of the lumen in spite of it being approximately 10 cm long, severe stricture of the esophagus was diagnosed. Because the stricture was very long and severe, and was not conservatively treatable, it was decided, after obtaining informed consent, that surgical resection of the esophagus would be performed. Subtotal esophagectomy with lymph node dissection and colonic interposition was carried out. During surgery, the patient was diagnosed as having liver cirrhosis. Histopathologic examination of the surgically resected specimen revealed a 10 cm‐long narrowing of the middle and lower thoracic esophagus with thick walls, particularly in the inner circular muscle layer, without malignancy. Unfortunately, the patient’s postoperative course was followed by cervical leakage. He subsequently died of multiple organ failure on the sixteenth postoperative day. It is worth keeping in mind that esophageal benign stricture with longitudinal ulceration can be induced by esophageal submucosal dissection, as seen in the present case.