S2371 Ripped by Chips: A Case Report of Esophageal Perforation After Consumption of Chips

Abstract

Introduction: Eosinophilic esophagitis (EoE) is an uncommon condition defined as a chronic, immune-mediated, esophageal disease characterized clinically by symptoms related to esophageal dysfunction and histologically by eosinophil-predominant inflammation.1 Patients typically present with esophageal dysphagia and food impaction. We present a unique and rare case presentation of a young male patient who presents with pneumomediastinum in the setting of undiagnosed EoE. Case Description/Methods: A 31-year-old male with no significant past medical history presents to the emergency department with lower neck pain. He reports sudden onset of pain after consuming a sandwich containing potato chips. This was followed by 2 immediate episodes of hematemesis. Vital signs were within normal limits. Physical exam was significant for bilateral crepitus on exam. CT Chest with contrast was significant for extensive pneumomediastinum around the esophagus suggestive of an esophageal perforation. CT neck was significant for extensive emphysema in the neck and pneumomediastinum with esophageal wall emphysema suggestive of esophageal rupture (Figure). An esophagram revealed no evidence of gross esophageal leak suggesting a contained micro perforation, so he was managed conservatively with IV pain medications, initial period of nil by mouth followed by slow escalation to a liquid diet. His diet was slowly escalated, and he was discharged home in stable condition. Two months later at an outpatient gastroenterology follow up, an esophagogastroduodenoscopy was significant for ringed esophagus, longitudinal furrows, white plaques and white specks throughout the entire esophagus. Biopsies were consistent with eosinophilic esophagitis with increase eosinophil count in the proximal esophagus. He was started on a daily proton pump inhibitor with ongoing follow up. Discussion: The incidence of EoE appears to be increasing, in part due to rising recognition of the disorder. It is important for physicians to identify its features early to prevent further complications. Esophageal perforation is a rare but serious complication of eosinophilic esophagitis, occurring in ∼2% of cases.2 Ongoing inflammation from longstanding untreated EoE has previously been reported to have led to esophageal perforation but rarely in such a dramatic fashion.3Figure 1.: 1. Significant emphysema in the neck and pneumomediastinum with thinning of the posterolateral aspect of esophagus concerning for esophageal rupture.