Congenital Esophageal Stenosis: with Special Reference to Diagnosis and Postoperative Complications

PURPOSE: Congenital esophageal stenosis(CES) is one of the rare causes of recurrent vomiting during infancy and childhood. We studied the diagnostic and therapeutic tools and postoperative complications for early diagnosis and adequate management of CES. METHODS: Fourteen cases of CES were evaluated for clinical manifestations, findings of esophagogram and esophagoscopy, classification of pathologic findings and postoperative complications. RESULTS: Most common clinical manifestations at onset were non-projectile vomiting(14), dysphagia to solids(13). Age at onset of symptoms corresponded with the introduction of solids in 11 cases. Esophagogram showed segmental stenosis of variable length in the lower portion of the esophagus in all cases with marked proximal dilatation in 11 cases. Esophagoscopy revealed no signs of esophagitis or ulcer at the area of stenosis. Segmental resection and primary anastomosis were performed as a definitive treatment modality in all cases except one with fibromuscular stenosis. Bronchial cartilage were present in all cases of tracheobronchial remnants(10). Abnormal arrangement and thickening of muscularis mucosae and inner circular muscle were found in all cases of fibromuscular stenosis(4). Postoperative complications were gastroesophageal reflux(5), stricture of anastomotic sites, reflux esophagitis, and so on. CONCLUSION: CES is rare but should be considered as a cause of recurrent vomiting and dysphagia to solid food beginning in infancy and childhood especially in the weaning period. Esophagogram and esophagoscopy are useful tools for diagnosis and differential diagnosis. The stricture of anastomosis site, gastroesophageal reflux and esophagitis need to be evaluated in the follow-up postoperative periods.

Takayasu's Arteritis: A Case Complicated with Acute Myocardial Infarction and Renovascular Hypertension

This report describes a 26-year-old man of Takayasu's arteritis complicated with acute myocardial infarction due to the occlusion of proximal left anterior descending artery and renovascular hypertension which was improved spontaneously without obstruction of stenotic renal artery. Coronary artery involvement and myocardial ischemic symptom in Takayasu's arteritis is uncommon and only about 10 case of acute myocardial infarction were reported. But most cases were diagnosed by autopsy after death. In this case, acute myocardial infarction developed during follow up after diagnosis of Takayasu's aortitis and coronary artery involvement was confirmed by coronary angingraphy. Hypertension is found in 40-70% of the cases. In our case hypertension was complicated and thought to be renovascular origin. It was refractory to medication including captopril. During follow up blood pressure was normalized spontaneously after wide fluctuations for 3 times. Now he is normotensive without medication. It is thought to give a new insight to the mechanism and treatment of renovascular hypertension.