Radiology Resident Case of the Week
Clinical Sx:
Severe inflammation of the esophagus and stomach with eventual severe, long segment esophageal narrowing and fibrosis with associated dysmotility. Strictures may also occur at up to 2 weeks after ingestion of the caustic substance. The stomach, particularly the antrum, also undergoes contraction/fibrosis and develops severe dysmotility as well.
Etiology/Pathophysiology
The lye is severely caustic to the esophagus and stomach.
Pathology:
Esophagus: Long ulcerated strictures may be observed in patients who have ingested lye or other caustic agents. Corrosive strictures tend to be long lesions involving large portions of the thoracic esophagus, sometimes extending the entire distance between the aortic knob and the diaphragm. In severe cases, diffuse esohageal narowing may reduce the thoracic esophagus to a thin, filiform structure. Long-standing lye strictures predispose patients to the development of esophageal carcinoma. Thus, any mucosal irregularity in a chronic lye stricture should raise the possibility of carcinoma.
Stomach: The ingestion of corrosive agents, primarily concentrated acids, causes a coagulative necrosis of the stomach that has a predilection to involve the antrum. The acute inflammatory process heals by fibrosis and scarring, which results in stricturing of the antrum within several weeks of the initial injury.
Miscellaneous
Imaging
DDX
Esophagus:
Severe reflux esophagitis.
Nasogastric-intubation esophagitis.
Radiation induced esophagitis.
Stomach: Linitis plastica secondary to gastric malignancy.
Key references
Eisenberg: Gastrointestinal Radiology. A Pattern Approach. 2nd Ed. pp.84, 215-6.
Laufer and Levine: Double Contrast Gastrointestinal Radiology. 2nd ed. pp. 148-9.
ACR Code
Keywords: