Correspondence

Esophageal Laceration Caused by a Bagel

N Engl J Med 1999; 340:241January 21, 1999

Article

To the Editor:

We report a serious esophageal injury caused by a bagel.

A 38-year-old woman experienced sudden odynophagia and severe upper substernal precordial pain while eating a bagel that had been baked within the previous eight hours. She had no history of dysphagia or heartburn. She was able to swallow her saliva and small sips of water, but swallowing intensified her pain immensely. A radiograph of the chest was normal. A barium-swallow examination showed a broad-based mucosal tear in the posterior wall of the upper portion of the esophagus, extending from the cricopharyngeal muscle inferiorly for at least 4 cm, with no extravasation.

The woman was admitted to the hospital. Narcotic analgesics, antacids, and intravenous hydration provided minimal relief of her pain. Endoscopy was postponed because she was not bleeding, had no signs of full-thickness esophageal injury, and was still able to swallow.

The next day a sequential esophagogram showed persistent but diminishing edema in the upper portion of the esophagus. The patient felt better and was sent home with instructions to follow a liquid diet.

Her symptoms gradually resolved during the next month. Eight weeks after the injury, the results of a barium-swallow examination, esophagoscopy (to assess the mucosal healing and to rule out any underlying abnormalities), manometric studies, and a 24-hour recording of pH were all normal.

Like Longstreth,1 who described an esophageal laceration caused by a tortilla chip, we recommend a simple approach in uncomplicated cases of food-induced laceration of the esophagus, without emergency endoscopy. With this approach, the risk of iatrogenic perforation of the esophagus or of secondary and cumbersome mucosal bleeding due to endoscopy can be avoided.

Abdallah K. Alameddine, M.D.
Boston Regional Medical Center, Stoneham, MA 02180

Mark J. Girard, M.D.
North Shore Medical Center, Salem, MA 01970

1 References

1. 1

   Longstreth GF. Esophageal tear caused by a tortilla chip. N Engl J Med 1990;322:1399-1400
   Web of Science | Medline

Citing Articles (1)

Citing Articles

1. 1

   George F. Longstreth, Jeffrey C. Buehler, Gordon C. Hunt, John J. Garvie, Daniel S. Anderson. (2007) Chips and rips: “chew your food well”. Gastrointestinal Endoscopy 65:3, 556
   CrossRef