Gastroesophageal intussusception: A new cause of acute esophageal obstruction in children

Gastrointestinal intussusception with obstruction is common in the small bowel and colon; however, such a process is not known to cause esophageal obstruction. Recent experience with gastroesophageal intussusception permits discussion of diagnosis and consideration of treatment options. A 3-year-old child presented with acute esophageal obstruction. Physical examination was significant for epigastric tenderness and excessive salivation. Chest x-ray showed a posterior mediastinal fullness. Esophagram documented a smooth crescent-filling defect, which caused obstruction of the esophagus at the level of the carina with proximal esophageal dilatation. Chest computed tomography of the thorax showed a soft tissue mass of the distal esophagus. Esophagoscopy confirmed occlusion of the midesophagus with the mucosa intact. A right thoracotomy permitted visualization of dilated proximal esophagus and a palpation of an intraluminal mass in the distal esophagus. Mobilization of the distal esophagus and gentle manual pressure cleared the obstruction to a point below the diaphragm. After a normal intraoperative esophagram, final treatment consisted of a longitudinal esophagomyotomy. The child recovered without complication and continues without recurrence for 18 months. This is the first report of gastroesophageal intussusception in children. Management by thoracotomy, manual reduction, and esophageal myotomy reestablished intestinal continuity and appears to eliminate recurrence; fundoplication or gastropexy may be alternative options. Preoperative recognition of gastroesophageal intussusception may allow nonoperative reduction or treatment by minimally invasive surgery.