Karl Andersen, DO1, Ryan T. Hoff, DO1, Dean N. Silas, MD2
1Advocate Lutheran General Hospital, Park Ridge, IL; 2Advocate Lutheran General Hospital, Niles, IL
Dysphagia lusoria is a rare intrathoracic vascular abnormality that results in the compression of the esophagus, causing dysphagia. The most common cause of dysphagia lusoria is an aberrant right subclavian artery of the aortic arch, though nearly all major arteries within the thorax have been reported to cause cause this condition.
68-year-old male with a history of developmental delay and imperforate anus s/p colostomy and colostomy revision presented with decreased appetite, decreased ostomy output, and regurgitation of food and water. Past medical history was notable for GERD and prior small bowel obstructions. Abdominal obstructive x-ray series showed multiple nondilated gas-filled loops of small bowel. Chest x-ray showed tortuosity of the thoracic aorta. Fluoroscopic swallow evaluation showed no evidence of aspiration, and barium esophagram showed the calcified aortic arch trapping the proximal esophagus anteriorly and posteriorly, resulting in a narrowed channel with a normal appearing distal esophagus (figure 1). CTA chest confirmed compression of the esophagus by the anomalous aortic arch (figure 2). Multiple treatment options were considered. However, due to the patient's poor performance status and ability to tolerate small frequent sips of liquids, no surgery was pursued. The patient was discharged home in satisfactory condition.
The majority of patients with dysphagia lusoria are asymptomatic and the discovery of the anomaly is often incidental. This patient had a tortuous thoracic aorta, which was known from previous imaging studies, but remained without dysphagia until this admission. The median onset of symptoms is 48-50 years; the late-onset of this condition may be due to the increased rigidity of the esophagus or calcification and atherosclerosis of the major vessels, decreasing their compliance. The presenting symptoms of dysphagia lusoria is usually progressive dysphagia, usually for solids, accompanied by regurgitation of unchewed foods, chest pain, or cough. The diagnosis is usually achieved with an initial barium esophagram, followed by CT or MRI scan. Endoscopic ultrasound with doppler is also used for diagnosis. Surgery is the preferred treatment option for symptomatic patients that can tolerate it. To our knowledge, this is the first reported case of dysphagia lusoria associated with development delay and isolated imperforate anus.
Citation: Karl Andersen, DO; Ryan T. Hoff, DO; Dean N. Silas, MD. P0312 - DYSPHAGIA LUSORIA ASSOCIATED WITH IMPERFORATE ANUS. Program No. P0312. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.