Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 26, 2020; 8(14): 3130-3135
Published online Jul 26, 2020. doi: 10.12998/wjcc.v8.i14.3130
Acute esophageal obstruction caused by reverse migration of gastric bezoars: A case report
Fu-Hua Zhang, Xiang-Ping Ding, Jin-Hua Zhang, Lian-Sheng Miao, Ling-Yu Bai, Hai-Lan Ge, Yong-Ning Zhou
Fu-Hua Zhang, Yong-Ning Zhou, Department of Gastroenterology, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
Fu-Hua Zhang, Yong-Ning Zhou, Key Laboratory for Gastrointestinal Diseases, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
Fu-Hua Zhang, Xiang-Ping Ding, Jin-Hua Zhang, Lian-Sheng Miao, Ling-Yu Bai, Department of Gastroenterology, Affiliated Hospital of Northwest Minzu University, Lanzhou 730000, Gansu Province, China
Hai-Lan Ge, Department of Radiology, Affiliated Hospital of Northwest Minzu University, Lanzhou 730000, Gansu Province, China
Author contributions: Zhang FH and Ding XP were attending physicians for the patient, reviewed the literature and contributed to manuscript drafting; Zhou YN and Zhang JH reviewed the literature and contributed to manuscript drafting; Miao LS and Bai LY performed the upper gastrointestinal endoscopy and endoscopic therapy, and contributed to manuscript drafting; Ge HL was responsible for imaging diagnosis and reviewed the literature; Zhou YN was responsible for revision of the manuscript for important intellectual content; all authors issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Yong-Ning Zhou, MD, PhD, Professor, Department of Gastroenterology, Key Laboratory for Gastrointestinal Diseases, the First Hospital of Lanzhou University, No. 1, West Donggang Road, Lanzhou 730000, Gansu Province, China. zhouyn@lzu.edu.cn
Received: March 28, 2020
Peer-review started: March 28, 2020
First decision: April 24, 2020
Revised: May 4, 2020
Accepted: July 4, 2020
Article in press: July 4, 2020
Published online: July 26, 2020
Processing time: 117 Days and 21.1 Hours
Abstract
BACKGROUND

Bezoars can be found anywhere in the gastrointestinal tract. Esophageal bezoars are rare. Esophageal bezoars are classified as either primary or secondary. It is rarely reported that secondary esophageal bezoars caused by reverse migration from the stomach lead to acute esophageal obstruction. Guidelines recommend urgent upper endoscopy (within 24 h) for these impactions without complete esophageal obstruction and emergency endoscopy (within 6 h) for those with complete esophageal obstruction. Gastroscopy is regarded as the mainstay for the diagnosis and treatment of esophageal bezoars.

CASE SUMMARY

A 59-year-old man was hospitalized due to nausea, vomiting and diarrhea for 2 d and sudden retrosternal pain and dysphagia for 10 h. He had a history of type 2 diabetes mellitus for 9 years. Computed tomography revealed dilated lower esophagus, thickening of the esophageal wall, a mass-like lesion with a flocculent high-density shadow and gas bubbles in the esophageal lumen. On gastroscopy, immovable brown bezoars were found in the lower esophagus, which led to esophageal obstruction. Endoscopic fragmentation was successful, and there were no complications. The symptoms of retrosternal pain and dysphagia disappeared after treatment. Mucosal superficial ulcers were observed in the lower esophagus. Multiple biopsy specimens from the lower esophagus revealed nonspecific findings. The patient remained asymptomatic, and follow-up gastroscopy 1 wk after endoscopic fragmentation showed no evidence of bezoars in the esophagus or the stomach.

CONCLUSION

Acute esophageal obstruction caused by bezoars reversed migration from the stomach is rare. Endoscopic fragmentation is safe, effective and minimally invasive and should be considered as the first-line therapeutic modality.

Keywords: Esophageal bezoars; Esophageal obstruction; Acute; Endoscopic fragmentation; Case report

Core tip: Esophageal bezoars are rare. The reverse migration of gastric bezoars to the esophagus leading to complete esophageal obstruction is even rarer. Our patient presented with sudden retrosternal pain, dysphagia and salivation after severe retching. Esophageal bezoars were diagnosed by computed tomography and gastroscopy. Endoscopic fragmentation using a mouse-tooth clamp and snare was successful, and there were no complications. This case demonstrates that retrograde migration of foreign bodies from the stomach leading to acute esophageal obstruction should be suspected when patients present with sudden retrosternal pain, dysphagia and salivation after retching.