Negotiating Dire Straits with a BougieCap

Excerpt

A 62-year old male was initially evaluated for a progressively worsening sensation of food getting lodged below his throat associated with a decrease in caloric intake and a 16 lb weight loss. His past history was significant for hospitalization 15 months prior to chest pain, nausea, vomiting, and odynophagia. CT scan showed circumferential mural thickening of the esophagus. An upper endoscopy revealed necrotic-appearing mucosa with biopsies showing evidence of acute ischemic injury. Four weeks later, he developed dysphagia to both liquids and solids. A follow-up upper endoscopy identified a 10-cm-long stricture, extending from mid- to distal esophagus with a lumen diameter as narrow as 4 mm. Balloon dilation with a through-the-scope (TTS) balloon was complicated by an esophageal perforation that was treated with an emergent thoracotomy, distal esophagectomy, and gastric pull-up and placement of a feeding jejunostomy (Fig. 1).

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