Scutaru Tabita Timeea, Kupcsulik Péter, Sahin Péter, Szücs Ákos
Semmelweis University's First Department of Surgery, Budapest, Hungary.
Jahn Ferenc South-Pest Hospital and Clinic, Budapest, Hungary.
Arch Clin Cases. 2021 Oct 27;6(2):37-47. doi: 10.22551/2019.23.0602.10152. eCollection 2019.
Eosinophilic esophagitis is a chronic, antigen-mediated inflammation of the esophagus. The disease is most common at young ages, with a male to female ratio of 3:1. Eosinophilic granulocyte infiltration induced by oral/aeroantigens in the esophagus, mucosal hyperplasia, and fibrosis of the subepithelial layers can lead to constriction, dysphagia, blockage and esophageal perforation.
A 36-year-old male patient presented in June 2016 with dysphagia as the main complaint. Workup with plain chest radiography with a water soluble contrast swallow did not reveal any pathological lesions. The patient's swallowing difficulties persisted and one year later he was treated by esophageal food bolus impaction (EFBI) in another institution. A new plain chest radiography with a water soluble contrast swallow confirmed a 9 cm long stricture in the middle third with an EFBI. During gastroscopy, a clinical picture of eosinophilic esophagitis was noted, with partially destroyed foreign body at 25cm and iatrogenic perforation at the upper half of the esophagus. After preoperative intensive care unit valuation and preparation, transhiatal esophagectomy without thoracotomy and cervical esophagostomy was performed with pyloromyotomy and feeding jejunostomy. The postoperative period was uneventful. Histological examination confirmed the presence of strictures and perforation on the background of eosinophilic esophagitis. Elective esophageal reconstruction with cervical esophagogastric anastomosis was performed on January 2018. Control blood tests revealed persistent eosinophilia, while the plain chest radiography with a water soluble contrast swallow showed no contrast leakage. Per os nutrition was resumed and the patient was discharged in good general condition.
Eosinophilic esophagitis is a rare and difficult to diagnose entity due to its non-specific clinical presentation. In order to avoid complications and undesired delay in diagnosis, one should take into consideration this entity in every clinical situation of a young male patient with swallowing complaints.
嗜酸性粒细胞性食管炎是一种慢性、抗原介导的食管炎症。该疾病在年轻人中最为常见，男女比例为3:1。口腔/气源性抗原诱导的嗜酸性粒细胞浸润、食管黏膜增生以及上皮下层纤维化可导致食管狭窄、吞咽困难、梗阻和食管穿孔。
一名36岁男性患者于2016年6月以吞咽困难为主诉就诊。胸部X线平片加水溶性造影剂吞咽检查未发现任何病理性病变。患者的吞咽困难持续存在，一年后他在另一家机构接受了食管食物团块嵌塞（EFBI）治疗。新的胸部X线平片加水溶性造影剂吞咽检查证实食管中三分之一处有一个9厘米长的狭窄，并伴有EFBI。胃镜检查时，发现了嗜酸性粒细胞性食管炎的临床表现，食管25厘米处有部分异物损坏，食管上半部分有医源性穿孔。经过术前重症监护病房评估和准备后，进行了经裂孔食管切除术，未开胸，行颈部食管造口术，并做了幽门肌切开术和空肠造口术用于喂养。术后恢复顺利。组织学检查证实了在嗜酸性粒细胞性食管炎背景下存在狭窄和穿孔。2018年1月进行了选择性食管重建术，采用颈部食管胃吻合术。实验室检查显示嗜酸性粒细胞持续增多，而胸部X线平片加水溶性造影剂吞咽检查未显示造影剂渗漏。恢复经口营养，患者出院时一般情况良好。
嗜酸性粒细胞性食管炎因其非特异性临床表现，是一种罕见且难以诊断的疾病。为避免并发症和诊断的不必要延误，对于每一位有吞咽主诉的年轻男性患者，在任何临床情况下都应考虑到这种疾病。
