Dilated Neo-esophagus Masquerading Around as a Pneumothorax

Abstract

Patient is a 53-year-old male with a pertinent past medical history significant for ingestion of lye at the age of 5 with numerous subsequent stomach and esophageal surgeries including an esophagectomy with colonic interposition and a pneumonectomy. The patient presented to the emergency department complaining of progressive shortness of breath. A chest x-ray was performed that was suspicious for a pneumothorax. A Chest CTA was then performed to further evaluate, as well as rule out pulmonary embolism, but noted severe dilation of interposed colon with debris and significant mass effect on the mediastinum. Patient underwent endoscopy and was found to have a significant narrowing likely at the anastomosis. Patient successfully underwent balloon dilatation at the stenotic area. Anastomotic stricture occurs in 5-40% of patients following esophageal resection and reconstruction. Strictures are generally due to continuing ischemia or with later presentations, recurrent disease at the site of anastomosis. A retrospect review of 393 esophagectomy patients concluded that 80% of patients who develop a stricture only 35% had evidence of an anastomotic leak or conduit ischemia (1). Strictures can be managed effectively by endoscopic dilatation, as was the case with this patient. Edoscopic dilatation was found to have a success rate for relieving symptoms as high as 93% in one study (2). Surgical revision of the anastomosis is rarely indicated and may require resection and diversion.Figure: Chest x-ray showing possible pneumothorax.Figure: Coronal view from chest CTA showing severe dilation of interposed colon with debris and significant mass effect in the mediastinum.