ESOPHAGEAL WEBS IN MEN.

Abstract

In the past, the Plummer-Vinson syndrome, comprising a web in the postcricoid region of the upper esophagus, dysphagia, koilonychia, and an iron-deficiency anemia, has been described as occurring predominantly in women. In recent years, however, reports of esophageal webs in men have appeared in the literature. Brunton and Eban (1) reported on 4 men with an iron-deficiency anemia (3 postgastrectomy), all showing webs in the upper esophagus and 3 having dysphagia. New (4) also describes a case in a male having a history of hemorrhage from a duodenal ulcer with an esophageal web and an associated anemia. Waldmann and Turnbull (6) describe esophageal webs in 4 patients, 3 of whom were males; only 2 of these had dysphagia and none showed evidence of anemia or koilonychia. Holinger, Johnston, and Potts (2), in a discussion of congenital anomalies of the esophagus, mention congenital webs, either single or multiple, occurring in the upper esophagus, and reproduce an x-ray film showing a double web in a child, indistinguishable from several shown in an article by Waldenström and Kjellberg (5). For the past eighteen months, at Passavant Memorial Hospital (Chicago, Ill.) the upper esophagus has been visualized routinely in approximately 2,500 patients undergoing examination of the upper gastrointestinal tract. Over half were male. Anteroposterior and lateral films of the cervical esophagus were obtained during the swallowing of a bolus of thick barium cream. In almost all patients, satisfactory distention of the upper esophagus was obtained in at least one projection. In the lateral view the web is seen as a radiolucent line projecting directly posteriorly from the anterior wall of the cervical esophagus at a level between the 5th and 7th cervical vertebrae. In several instances that portion of the esophagus immediately beneath the web did not fill with barium, apparently indicating a partial obstruction to fluid. In the anteroposterior view the web was seen as a bilateral sharp impression on the margins of the barium-filled esophagus, and in at least 2 patients an arc-like radiolucent line was observed, connecting the lateral indentations. During this time, esophageal webs have been observed in 9 patients, all male, none with symptoms of dysphagia, 5 showing mild anemia during the course of follow-up, and 1 having polycythemia vera. Case Reports Case I: J. C., a 46-year-old asymptomatic white male, had a history of removal of a mediastinal lipoma in 1956. He showed no evidence of stomatitis, glossitis, or koilonychia. Hemoglobin in 1960 was 16.6 gm. per cent, and in 1962, 14.8 gm. per cent, with a packed cell volume of 47 per cent. Radiographs obtained Feb. 12, 1962, revealed a postcricoid web, a small hiatus hernia, and an otherwise normal gastrointestinal tract. Case II: E. P., a 41-year-old white male, was admitted with a short history of right-sided abdominal pain, with no dysphagia.