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Barrett's epithelium with complete stricture of the esophagus: hypothesis of its etiology
1Department of Surgery, Beijing Children's Hospital, People's Republic of China.
Insights
A congenital esophageal obstruction in a child was successfully treated with surgical resection and anastomosis. This case highlights the management of severe esophageal stricture, even with Barrett
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Pathology
Background:
- Congenital esophageal obstruction presents a significant challenge in pediatric care.
- Barrett's epithelium, a metaplastic change in the esophageal lining, can be congenital.
Observation:
- A 4-year-old boy with a history of recurrent vomiting since birth presented with severe dehydration due to complete esophageal obstruction.
- Diagnostic imaging and esophagoscopy revealed a stricture between the middle and lower thirds of the esophagus.
Findings:
- Surgical resection of the obstructed 4 cm segment of esophagus followed by end-to-end anastomosis was performed.
- Pathological examination confirmed complete obstruction, Barrett's epithelium above and below the stricture, and severe periesophagitis due to sealed perforation.
Implications:
- Successful surgical intervention can effectively resolve severe congenital esophageal strictures.
- While Barrett's epithelium may be congenital, complications like strictures often result from chronic irritation, such as gastroesophageal reflux.
Abstract:
A 4-year-old very debilitated boy, who suffered from recurrent vomiting (regurgitation) since birth, is described. At the age of 18 months, partial obstruction of the esophagus was apparent, and only semisolid food could be swallowed. The signs of obstruction progressed, and the child was admitted urgently, at the age of 4 years, to the authors' department because of severe dehydration. After resuscitation, a barium swallow and esophagoscopy showed a complete obstruction of the esophagus between its middle and lower third. Through a left thoracotomy incision, 4 cm of the diseased esophagus were resected and continually established by end-to-end esophagoesophageal anastomosis. Pathological examination showed complete obstruction of the esophagus with Barrett's epithelium above and below the stricture. Severe periesophagitis was also present because of sealed perforation of the esophagus. One week after the operation the child was on a normal diet. On follow-up, 6 months later, he has no signs of obstruction and is gaining weight. It is postulated that the presence of Barrett's epithelium in the esophagus in congenital, but the complications, such as stricture formation, are usually caused by chronic irritation, such as gastroesophageal reflux. Barrett's epithelium alone infrequently will cause