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Eine impaktierte „Wiener Semmel“ im Ösophagus – Erstmanifestation einer eosinophilen Ösophagitis bei einem 17-jährigen Patienten

Impaction of a “Sausage Bread” in the Esophagus – First Manifestation of an Eosinophilic Esophagitis in a 17-Year-Old Patient

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Zusammenfassung

Ein 17-jähriger Patient wurde aufgrund eines impaktierten Nahrungsbolus von den Kollegen der Hals-Nasen-Ohren-Klinik in der internistischen Notaufnahme vorgestellt. Die HNO-ärztliche Untersuchung zeigte deutliche Speichelseen in beiden Recessus piriformes, die radiologische Untersuchung des Ösophagus ergab einen 1,6 cm messenden Fremdkörper im Bereich des ösophagogastralen Übergangs mit einem proximalen Kontrastmittelspiegel.

In der klinischen Untersuchung und der Laborchemie fanden sich keinerlei Auffälligkeiten. Es folgte die Durchführung einer Notfallösophagogastroskopie. Hier zeigte sich der in der Breischluckuntersuchung nachgewiesene Fremdköper im Bereich des gastroösophagealen Übergangs. Der als Nahrungsbolus identifizierte Fremdkörper wurde mittels Gastroskop vorsichtig in den Magen vorgeschoben. Im Magen befanden sich weitere Nahrungsreste, so dass die Untersuchung bei Aspirationsgefahr abgebrochen wurde. In einer am Folgetag elektiv durchgeführten Gastroskopie wurden aus dem Ösophagus Stufenbiopsien bei klinischem V.a. eosinophile Ösophagitis (EÖ) entnommen. Die histologische Aufarbeitung ergab eine deutliche Eosinophilie (> 15 Eosinophile/HPF bei 400facher Vergrößerung) und reaktive Veränderungen im distalen Ösophagus. Somit wurde die Diagnose einer EÖ gestellt. Eine Therapie mit Fluticason führte zu einer deutlichen Symptombesserung, erneute Bolusimpaktionen traten im Verlauf nicht mehr auf.

Abstract

A 17-year-old patient was transferred to the emergency room with an impacted food bolus by colleagues from the Department of Otorhinolaryngology. The examination of ear, nose and throat revealed significant amounts of saliva in both recessus piriformes, a radiologic examination of the esophagus showed a foreign body with a diameter of 1.6 cm in the region of the transitional zone of esophagus and stomach with a support level of the contrast medium.

Clinical examination and laboratory tests showed no abnormalities. An emergency gastroscopy was performed. The foreign body, already evident in the barium swallow, was found in the distal esophagus. The foreign body was identified as a food bolus and gently advanced into the stomach with the aid of the gastroscope. In the stomach further food residues were detected and the examination was aborted because of increased risk of aspiration. On the next day, an elective gastroscopy was performed. Several biopsies were obtained from the esophagus because eosinophilic esophagitis (EE) was suspected due to clinical symptoms. Histological work-up showed a significant amount of eosinophilic granulocytes (> 15 eosinophils/HPF, 400×) and reactive changes in the distal esophagus. Therefore, EE was diagnosed. Fluticasone therapy led to amelioration of symptoms and there was no evidence of recurring bolus impaction during follow-up.

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Correspondence to Erwin Gäbele.

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Gäbele, E., Endlicher, E., Zuber-Jerger, I. et al. Eine impaktierte „Wiener Semmel“ im Ösophagus – Erstmanifestation einer eosinophilen Ösophagitis bei einem 17-jährigen Patienten. Med Klin 104, 386–391 (2009). https://doi.org/10.1007/s00063-009-1077-8

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