Long peptic strictures of the esophagus due to reflux esophagitis: a case report

Abstract

Background: Most of benign esophageal strictures caused by gastroesophageal reflux are short segments and can be treated by an endoscopic dilatation, but cases of long-segment stenosis requiring an esophagectomy are rare.

Case presentation: A 62-year-old woman had undergone emergency surgery for a giant ovarian tumor rupture at another hospital. A duodenal perforation occurred after surgery but improved with conservative treatment. She had undergone long-term nasogastric tube placement for 4 months because she was on a mechanical ventilator and did not receive proton pump inhibitors (PPIs). Thereafter, the patient experienced dysphagia. An esophagogastroduodenoscopy (EGD) revealed circumferential reflux esophagitis (grade D) and a stricture located 25 to 40 cm from the incisor teeth. She received medical treatment with fasting and PPIs. The second EGD revealed that the reflux esophagitis had improved somewhat, but that the esophageal stricture had worsened. Thereafter, balloon dilatation was attempted, but the stricture did not improve and she was referred to our hospital. Finally, she was diagnosed as having a benign esophageal stricture caused by reflux esophagitis. She underwent a thoracoscopic esophagectomy with gastric tube reconstruction through the antethoracic route. Her postoperative course was uneventful. Pathologically, a circumferential stricture with white scar formation and no malignant cells were observed.

Conclusions: We experienced a rare case requiring esophagectomy for long-segment stenosis caused by reflux esophagitis. It is suggested that the possibility of esophageal stricture needs to be kept in mind when treating GERD patients with long-term nasogastric tube placement.

Keywords: Esophagectomy; Reflux esophagitis; Stricture.

Fig. 1

Upper gastrointestinal series. A severe stricture measuring 85 mm along the longitudinal axis was observed extending from the middle to lower thoracic esophagus

Fig. 2

Esophagogastroduodenoscopy. A cicatricial stricture beginning 25 cm from the incisor teeth was observed. The stricture made it difficult to pass a small-diameter scope through the esophagus

Fig. 3

Preoperative CT. a Transverse image. b Coronal image: marked thickening of the esophageal wall was observed from the middle to lower thoracic esophagus

Fig. 4

Findings during thoracoscopic mobilization of the middle and lower esophagus. A severe fibrotic change between the esophagus and the descending aorta was observed

Fig. 5

Gross and microscopic findings. a Macroscopically, a long segment of circumferential thickening of the esophageal wall was observed. b Erosion and ulceration were visible (HE staining, ×20). c Inflammatory cell infiltration was observed. No malignant findings were seen (HE staining, ×100)