A high stricture
This patient is attending for dilatation of a high oesophageal stricture but there is a surprise.
WHAT IS THE CAUSE OF THE STRICTURING?
■ Corrosive ingestion
Yes, a likely cause of 2 high oesophageal strictures
■ Peptic ulceration
In the high oesophagus?!?
■ Lichen planus
Possible but never seen two !
■ Eosinophilic oesophagitis
They are not short and membrane-like!
The mucosa is unremarkable!!!
The 'surprise finding' is of course that there are TWO strictures some 2-3cm apart in the high oesophagus. All of the above could be the cause, I guess. Of course, the stricture does not look malignant. Eosinophilic oesophagitis gives smoother, long tapering strictures, not short membrane-like strictures like this. Peptic ulceration would be unlikely in the high oesophagus (unless there is a long stretch of Barrett's below). Lichen planus is a possibility but the fact that there are more than one strictures, makes corrosive ingestion the most likely diagnosis. Actually, the patient had been admitted after swallowing a lot of toilet cleaner a few months earlier.
in the images below you can see what her oesophagus looked like after that alkaline burn. I wonder if giving a reducing dose of steroid, like we do after large oesophageal EMR's could have prevented her stricture?