Severe long esophageal stricture following hyperemesis gravidarum

Abstract

We report a 32-year-old female patient with esophageal stricture thought to have been caused by hyperemesis gravidarum. Eleven months before admission she had been admitted to another hospital, because of hyperemesis gravidarum, at 26 weeks of gestation. Marked and recurrent vomiting occurred and her consciousness gradually worsened. Three weeks later, her baby was delivered by Cesarean section. Postpartum progress was uneventful except that she developed dysphagia 5 months after delivery. Esophagography and upper endoscopy demonstrated severe esophageal stricture. Endoscopic balloon dilatation was performed four times, but was unsuccessful. Blunt dissection of the esophagus was then performed. Histological examination demonstrated marked fibrosis in the submucosal layer and muscular hypertrophy. Esophageal glands were not identified. In this case, esophageal stricture might have been associated with severe esophagitis due to recurrent vomiting and reflux of gastric contents during hyperemesis gravidarum.

Severe benign esophageal stricture following postoperative emesis

“…Although patients experiencing esophageal injury generally complain of severe chest pain and hematemesis [8][9][10], patients at a low level of consciousness are unable to report symptoms and consequently cannot undergo appropriate therapy. A report of a patient suffering from esophageal stricture due to hyperemesis gravidarum described disturbances in consciousness and no symptom of esophageal injury [6]. In our case, the patient did experience postoperative delirium around the second day after surgery, after which he had no recollection of emesis, chest pain, or hematemesis.…”

“…Several different operative procedures are available for esophageal stricture resection. One is a blunt esophageal dissection without thoracotomy, followed by reconstruction with the stomach [6]. Another is esophageal resection via right thoracotomy, as in the resection of esophageal cancer [7].…”

“…There have been several reports of esophageal stricture formation during pregnancy [3][4][5][6]. In such a case, esophageal stricture was reported to appear within 1 week of severe emesis during delivery or hyperemesis gravidarum.…”

“…Here we describe a rare case of severe esophageal stricture, supposed to be caused by postoperative emesis, which ultimately required surgical treatment. We review previous literature similar cases [3][4][5][6][7] and discuss the etiology of esophageal strictures after emesis.…”

Esophagogastrectomy for Long-Segment Recurrent Esophageal Stricture Following Hyperemesis Gravidarum

“…Another case report in 2006 describes a young female who was five months postpartum when she developed dysphagia. She was also found to have a 7-cm long esophageal stricture refractory to endoscopic dilatation with treatment ultimately requiring esophageal resection [ 8 ].…”