Zhang Fu-Hua, Ding Xiang-Ping, Zhang Jin-Hua, Miao Lian-Sheng, Bai Ling-Yu, Ge Hai-Lan, Zhou Yong-Ning
Department of Gastroenterology, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China.
Department of Gastroenterology, Affiliated Hospital of Northwest Minzu University, Lanzhou 730000, Gansu Province, China.
World J Clin Cases. 2020 Jul 26;8(14):3130-3135. doi: 10.12998/wjcc.v8.i14.3130.
Bezoars can be found anywhere in the gastrointestinal tract. Esophageal bezoars are rare. Esophageal bezoars are classified as either primary or secondary. It is rarely reported that secondary esophageal bezoars caused by reverse migration from the stomach lead to acute esophageal obstruction. Guidelines recommend urgent upper endoscopy (within 24 h) for these impactions without complete esophageal obstruction and emergency endoscopy (within 6 h) for those with complete esophageal obstruction. Gastroscopy is regarded as the mainstay for the diagnosis and treatment of esophageal bezoars.
A 59-year-old man was hospitalized due to nausea, vomiting and diarrhea for 2 d and sudden retrosternal pain and dysphagia for 10 h. He had a history of type 2 diabetes mellitus for 9 years. Computed tomography revealed dilated lower esophagus, thickening of the esophageal wall, a mass-like lesion with a flocculent high-density shadow and gas bubbles in the esophageal lumen. On gastroscopy, immovable brown bezoars were found in the lower esophagus, which led to esophageal obstruction. Endoscopic fragmentation was successful, and there were no complications. The symptoms of retrosternal pain and dysphagia disappeared after treatment. Mucosal superficial ulcers were observed in the lower esophagus. Multiple biopsy specimens from the lower esophagus revealed nonspecific findings. The patient remained asymptomatic, and follow-up gastroscopy 1 wk after endoscopic fragmentation showed no evidence of bezoars in the esophagus or the stomach.
Acute esophageal obstruction caused by bezoars reversed migration from the stomach is rare. Endoscopic fragmentation is safe, effective and minimally invasive and should be considered as the first-line therapeutic modality.
胃石可在胃肠道的任何部位发现。食管胃石较为罕见。食管胃石分为原发性或继发性。由胃逆向迁移导致的继发性食管胃石引起急性食管梗阻的情况鲜有报道。指南建议，对于这些未完全梗阻的嵌塞物应紧急进行上消化道内镜检查（24小时内），对于完全性食管梗阻者应进行急诊内镜检查（6小时内）。胃镜检查被视为食管胃石诊断和治疗的主要方法。
一名59岁男性因恶心、呕吐、腹泻2天以及突发胸骨后疼痛和吞咽困难10小时入院。他有9年2型糖尿病病史。计算机断层扫描显示食管下段扩张、食管壁增厚、食管腔内有一个伴有絮状高密度影和气泡的肿块样病变。胃镜检查发现食管下段有固定不动的褐色胃石，导致食管梗阻。内镜下碎石成功，且无并发症发生。治疗后胸骨后疼痛和吞咽困难症状消失。在食管下段观察到黏膜浅表溃疡。食管下段的多个活检标本显示为非特异性结果。患者无症状，内镜下碎石1周后的随访胃镜检查显示食管和胃内无胃石迹象。
由胃逆向迁移导致的急性食管梗阻引起的胃石罕见。内镜下碎石安全、有效且微创，应被视为一线治疗方式。
