Esophageal food impaction in children: two cases of unusual causes.

Esophageal food impaction is rare in normal children. This problem is most frequently seen in adults and is rarely seen in children. In adults most patients have underlying esophageal disorder or from undiagnosed illness. A 15-year-old male presented with chest pains during dinner after eating a piece of meat. He had some mild dyspnea. PMH was remarkable for tracheoesophageal fistula (TEF) repair in the newborn period, dextrocardia, and asthma. He took omeprazole and fluticasone/salmeterol diskus. His physical examination was unremarkable. His esophagram revealed an irregular intraluminal filling defect in the distal one third of the esophagus. He was taken to the operating room and was found to have an esophageal stricture and the stricture was resected with primary reanastomosis. A 13-year-old female presented after ingestion of a hot-dog mid chest pains, cough and dysphagia. ROS revealed her to be falling backwards and progressive upper extremity weakness during the day. PMH was unremarkable. Neurologic exam showed a motor strength 2/5 in the upper extremity, normal sensation, reflexes and cranial nerves. She had dysmetria. Her esophagram showed an irregular intraluminal filling defect in the distal esophagus. She was given an edrophonium test and her symptoms improved. She was admitted for the new diagnosis of Myasthenia gravis. The hot dog passed on its own and she was discharged on pyridostigmine. Esophageal strictures have been a known complication of TE fistula repair and the presence of food impaction should exclude an underling stricture. Appropriate management is removal of the impaction and resection or dilation of the stricture. Myasthenia gravis as a cause of food impaction in children has not been described, but these patients are at increased risk. With a careful review of symptoms and exam this entity can easily be diagnosed and appropriate therapy instituted to prevent further morbidity.

Antonio E. Muniz, MD, Chris Woleben, MD, Sam Bartle, MD, Robin L. Foster, MD, and Steve Liner MD. Department of Emergency Medicine and Pediatrics, Virginia Commonwealth University Medical Center, Richmond, VA.