Post-caustic esophageal stenosis: case report

Abstract

Background: Post-caustic esophageal stenosis (PCES) is a benign condition resulting from the ingestion of corrosive chemicals, such as strong acids or bases, leading to necrosis, inflammation, and fibrosis of the esophageal mucosa. Treatment depends on the severity and may include endoscopic dilations, prostheses, or surgery, with multidisciplinary management of these patients being essential.

Aim: To report a case of PCE treated at our service.

Methodology: This is the case of a patient treated at the São Francisco University Hospital in Providência de Deus (HUSF), located in the city of Bragança Paulista, Sao Paulo, Brazil. Case Report: A 53-year-old patient, born in Atibaia - SP, Brazil, with a history of caustic soda ingestion in childhood, multiple esophageal dilations until the age of 17, and smoking (40 packs/year), presented with progressive dysphagia and food impaction. Upper digestive endoscopy revealed esophageal stenosis 25 cm from the upper dental arch, making it impossible to pass a nasoenteral tube. Tomography showed circumferential thickening of the middle/distal esophagus, and bronchoscopy revealed bulging of the left bronchus due to extrinsic compression. She underwent gastrostomy with biopsy, the result of which showed chronic nonspecific esophagitis, without excluding malignancy. Considering the risk factors and the desire to resume oral feeding, transhiatal esophagectomy was performed using the McKeown technique. The procedure occurred without technical complications, with good gastric tube perfusion and hemodynamic stability. In the postoperative period, she presented respiratory complications that were managed clinically, remaining hospitalized for 17 days. She was discharged with a soft diet via nasoenteral tube and good clinical evolution. The pathological examination revealed active chronic esophagitis with extensive fibrosis and chronic antral gastritis, without dysplasia or malignancy.

Conclusion: This is a case of late esophageal stenosis secondary to a caustic lesion in a patient at high risk for malignant transformation due to chronic inflammation and smoking. Transhiatal esophagectomy using the McKeown technique was indicated to restore the oral feeding route and remove an esophageal segment at risk for cancer. The outcome was favorable, with no evidence of neoplasia on pathological examination, highlighting the importance of prolonged follow-up and early surgical intervention in similar cases.