Obstruction of the esophagus by diseased ectopic gastric mucosa.

In the past decade, advances in anesthesiology, antibiotics, preand post-operative care and surgical technique have greatly increased the scope of thoracic surgery. Among those profiting by these advances, is the individual suffering from esophageal obstruction. Recently reported benign lesions producing esophageal obstruction indude acylasia, chemical obstruction, congenital obstruction, webs, congenital strictures, perforation (spontaneous and traumatic) and fistulae. It is our purpose to present two cases of esophageal obstruction due to diseased ectopic gastric mucosa and to emphasize the desirability of carefully evaluating the cause of obstructive lesions in order to remove the possibility of overlooking a non-malignant lesion. Inasmuch as diagnosis of such lesions today is often based upon direct visualization by esophagoscopy and by barium studies, it is possible to believe that some so-called malignancies of the esophagus are in truth quite benign and amenable to surgical correction. It has been the experience of many thoracic surgeons and pathologists that repeated attempts at biopsy of such lesions have failed to prove the presence of a cancer. In such instances, the clinical diagnosis of carcinoma, although unsupported, often prevails and Is accompanied by unjustified pessimism. On the basis of the following two cases it is believed that a more detailed study of possible benign lesions of the esophagus is mandatory. Ectopic gastric mucosa is not an infrequent finding. It has been reported in the upper third of the esophagus,’4’7 the lower third of the esophagus,’#{176}’4’8 within gastric cysts of the mediastlnum,34’3’6 chronically Inflamed gall bladders, cysts of the pancreas, Meckel’s diverticula’2,568’9, ’,’5,’7 chronic tuberculous ulcers of the colon6 and in teratomas. These islands of gastric mucosa, no matter where they may occur, are subject to all the diseases and malformations to which gastric mucosa is heir. These include acute and chronic inflammations, ulcerations, polypold hyperplasias, and hypertrophies. When symptoms arise from such ectopic foci, they usually are due to ulceration of the focus with subsequent hemorrhage and/or pain. In each of the cases presented here, however, the primary symptom was esophageal obstruction which later proved to be caused by ectopic foci of gastric mucosa which had become diseased.