Images in Clinical Medicine
Visible Peristalsis
N Engl J Med 2010; 362:e68June 17, 2010
- Article
Video
Visible Peristalsis
A 52-year-old man presented with lethargy and acute hyponatremia associated with alcohol intoxication and poor oral intake. He had a history of total esophagogastrectomy with jejunal anastomosis owing to necrotic injury from ingestion of a lye-containing cleaner 20 years earlier. In addition, he had a history of ongoing alcohol abuse and dysphagia. On physical examination, isoperistaltic movements were visible in the area where the jejunum had been transplanted to replace the esophagus (video). Esophagectomy may be required because of caustic esophageal injury or cancer. It often requires interposition of the stomach. If the stomach is unavailable, as in this patient, colon or small bowel may be used. At the time of the patient's initial esophagogastrectomy, an antesternal approach was used for the final anastomosis, rather than a substernal or transthoracic approach, which is more commonly used. As a consequence of the altered anatomy, patients who have undergone this procedure often have dysphagia, rapid gastric emptying (dumping syndrome), electrolyte abnormalities, and failure to thrive. This patient was treated with intravenous fluids, multivitamin supplementation, and resumption of an oral diet and had a full recovery.
Kush Agrawal, M.D.
Matthew Certain, M.D.
Emory University, Atlanta, GA
kagraw2@emory.edu
