Abstract
D A 70-year-old man was admitted with acute dysphagia to solids and liquids. He had a history of gastroesophageal reflux disease, Barrett’s esophagus, and large hiatal hernia, and he had previously undergone three antireflux surgical procedures, including a Nissen fundoplication, and then two repeated operations, the first through a left thoracoabdominal approach and the second through a right thoracotomy. His most recent endoscopy, performed for surveillance of Barrett’s esophagus 2 months before admission, showed long segment Barrett’s esophagus, a hiatal hernia with patent hiatal narrowing (A) and large gastric wrap folds around the cardia on retroflexed view (B). Upon admission, an esophagogram revealed distal esophageal obstruction. Upper endoscopy showed a mildly dilated esophagus and intussusception of gastric folds within t
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