Butterfly in the Esophagus: A Case Report on a Rare Esophageal Manometry Catheter Malposition.

We report the case of a 75-year-old man who underwent high-resolution manometry (HRM) testing for solid food dysphagia after an unrevealing upper endoscopy and biopsies. A barium esophagogram confirmed nonspecific motility disorder. A subsequent HRM study was performed, but when all swallow studies were noted to fail, and the manometric images revealed a butterfly wings appearance, it was found that the manometry catheter was actually coiled and folded back cephalad. As there are only a few other case reports with similar presentations, we believe this case would serve as a good reminder for clinicians to practice caution when cannulating the manometry catheter.