Treatment of Esophageal Stricture Complicated by Sudden Death

Abstract

An elderly lady with arteriosclerotic cardiovascular disease had had dysphagia intermittently for five years before she came under treatment for a benign esophageal stricture which was associated with an hiatal hernia. When her condition became refractory to bouginage and to the passage of beads over a previously swallowed thread, an attempt was made “to soften” the hard fibrous stricture by injecting triamcinolone mixed with hyaluronidase into it. The obstructing fibrous tissue was not softened immediately after the injection of these drugs. Four days later, with the hope that the steroid had “softened” the fibrous stricture, the patient swallowed a thread preliminary to the passage of dilating beads over it. She retired with the thread in place. During the night she was heard to cough and she was found to be dead five minutes later. At necropsy an hiatal hernia with a benign stricture of the lower esophagus was found. Needle tracts were seen in the stricture and deposits of injected material could be seen in the tissues; one tract went through the esophageal wall and there was minor mediastinitis with abscess formation. However, when the stomach and esophagus were distended with a solution of formalin under pressure, no leak could be found. A small thromboembolus in the lower lobe of the right lung might have caused the patient's death.