A Case Report of Congenital Esophageal Stenosis Due to Tracheobronchial Remnants Accompanied With Esophageal Motility Disorders Mimicking Esophageal Achalasia

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  • 食道アカラシア様の食道運動障害を合併した気管原基迷入型食道狭窄症の1例

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Abstract

We report a 3-year-old boy who presented with dysphagia since he was 7 months old. Barium swallow examination revealed the presence of a stenosis at the lower end of a dilated esophagus. Manometric study showed findings closely mimicking esophageal achalasia, such as intra-esophageal pressure higher than that of the gastric fundus, no relaxation of the lower esophageal sphincter upon stimulation with cold water, and positive methacholine test. Esophageal achalasia was suspected preoperatively. During operation, we found small nodules in the lower esophageal wall, and intraoperative pathological examination revealed tracheobronchial remnants in them. Resection of the lower esophageal stricture, end-to-end anastomosis, and anti-reflux operation were performed. Postoperative pathological examination revealed not only bronchial cartilage and bronchial glands in the esophageal wall, but also degeneration of ganglion cells of myenteric nerve plexus. Because dysphagia disappeared, and esophageal motility improved postoperatively, the esophageal achalasia-like motility disorders were thought to be secondary to the congenital esophageal stenosis due to trancheobronchial remnants. Prior Japanese literatures report some cases of congenital esophageal stenosis due to tracheobronchial remnants accompanied with esophageal achalasia-like motility disorders. If preoperative diagnosis is uncertain, it is important to feel out nodules in the lower esophageal wall during operation.

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