Congenital Reduplication of the Esophagus

Abstract

On occasion, a case of such rarity is seen that its inclusion in the literature is indicated. For this reason an example of partial reduplication of the esophagus is being reported, together with a brief summary of the literature on the subject. Case Report W. A., a 10-year-old white boy, was admitted to the State of Wisconsin General Hospital on Sept. 22, 1941, complaining of “trouble in swallowing.” The family history was negative for congenital malformations or other significant disease. In addition to the usual exanthemata, the patient, at the age of eight, had a six weeks illness characterized by moderate fever, a stiff neck, back, and legs, and severe headache, but no convulsions, twitchings, or paralysis. His physician made a diagnosis of meningitis. Recovery was complete. Physical and mental development were entirely normal. During his fifth year the patient began to experience dysphagia, particles of food becoming lodged in his throat. At such times the particular item of food would descend no farther nor could it be regurgitated, and it was necessary for the physician to force the obstructing food into the stomach with a rubber tube. Following this procedure the patient would be asymptomatic, but until it had been performed he would be unable to swallow even water. Such incidents occurred only once or twice a year. Occasionally the patient was able to “work it up” himself. He learned to chew his food well and to drink large amounts of fluids. A year and a half before entry, he found that vomiting induced immediately was successful in bringing up the offending food. Following an appendectomy in August 1941, he was unable to swallow for three days and was then relieved of symptoms temporarily after vomiting a cupful of “brown and bloody” material. Early recurrence of dysphagia, however, forced him to adopt a liquid diet. For a week prior to entry he had been bothered by regurgitation and reswallowing after most meals, symptoms that had occurred rarely in previous years. The child was bright and co-operative, well developed, and fairly well nourished, without acute symptoms. The only positive finding by physical or laboratory examination was a mild anemia (hemoglobin 75 per cent). An upper gastro-intestinal series on Sept. 22, 1941, revealed a bifurcation of the mid esophagus for a distance of about 13 cm. The barium mixture descended normally to the point of bifurcation, divided, and then descended through both channels. There appeared to be a moderate predominance in function of one channel, and its lumen was somewhat greater in diameter than the other. In the lower thorax they reunited into a single structure which entered the stomach in normal fashion (Fig. 1). The stomach and duodenum were normal. Immediate gastric emptying was satisfactory. The patient was discharged on Sept. 26, 1941. Surgery was to be considered at a later date.