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Volume 83 - 2020 - Fasc.3 - Clinical images

Ringed esophagus sign on barium esophagogastroduodenoscopy

A 35 year-old male patient with history of atopy was referred to the general surgery consultation with non-specific esophageal discomfort and occasional food impaction, especially with meat. Symptoms were discontinuous and had started approximately two years earlier. A barium esophagogastroduodenoscopy (EGD) was ordered on suspicion of achalasia (Fig. 1). What is the most likely diagnosis according to the imaging findings?


An unsuspected cause of esophagitis and esophageal stenosis – Looking beyond endoscopy findings

An 89-year-old woman was admitted to the ER with 1-week onset of odynophagia, vomiting and alimentary intolerance. She had medical history of hypertension, dyslipidemia and anemia, usually taking furosemide, perindopril, simvastatin and ferrous sulfate/folic-acid. Esophagogastroduodenoscopy (EGD) identified food impaction immediately distal to the upper esophageal sphincter (UES), which was easily mobilized to the stomach. In a second visualization a circumferential ulceration of the upper esophagus was observed (Figure 1a-b). The patient was discharged medicated with proton- pomp inhibitor twice daily and sucralfate. Soft diet was recommended.


Uncommon cause of acute abdomen in adult patient

A 41-year-old woman presented with acute abdominal pain, constipation and vomiting. Past history included immunotherapy for metastatic lymphnodes in the right axilla from metastatic melanoma of unknown primary for 20 months. No clinical response occurred and chemotherapy with carboplatin and placitaxel was performed for 4 months obtaining stable disease. At admission, physical examination revealed acute abdomen with pain, distension and absent bowel sounds. Laboratory tests were unremarkable. Computed tomography (CT) scan showed ileocolic invagination with dilated proximal small bowel (Fig. 1)