Introduction

• Cause:
  • Post-anesthetic stricture (most common).
  • Traumatic foreign bodies.
  • Ingestion of caustic materials (rare)/medication, eg doxycycline.
  • Accidental trauma.
• Most common sequel to esophagitis.
• Signs: dysphagia, salivation, pain on swallowing, regurgitation - developing over several weeks.
• Site: thoracic inlet and between base of heart - cardia.
• Important sequelae: aspiration of regurgitated ingesta, megaesophagus cranial to stricture.
• Treatment: dilation by serial bougienage or balloon dilation.
• Prognosis: guarded to poor, frequently recur.

Pathogenesis

Etiology

• Acquired at time of general anesthesia (most common).
• Trauma due to foreign bodies Esophagus: foreign body.
• Ingestion of caustic materials (rare)/medication, eg doxycycline, benzalkonium chloride.
• Subsequent upon esophageal surgery.
• Accidental trauma.
• Associated with persistent right aortic arch Vascular ring anomalies.
• Occasionally neoplasia.
• Idiopathic.

Specific

• Prior general anesthesia for abdominal surgery.

Pathophysiology

• Post-anesthetic stricture (most common) - erosive reflux esophagitis due to pooling of acidic gastric contents following relaxation of gastro-esophageal sphincter during general anesthetic.

• Clinical signs develop within 1-6 weeks of anesthetic episode/inciting cause.
• Initially fluids tolerated - eventually these regurgitated also.
• Can be anywhere along thoracic esophagus.
• Aspiration of regurgitated ingesta and development of megesophagus cranial to stricture - important sequelae.

Timecourse

• Clinical signs develop within 1-6 weeks of inciting cause.

Diagnosis

Treatment

Prevention

Outcomes