SHM Converge Scientific Abstract ePoster Gallery-Food's Impact on Esophageal Perforation - A "Tear"ible Case of Eosinophilic Esophagitis

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This case report describes a 48-year-old man with no major past medical history who developed chest pain and shortness of breath after eating a bagel. He felt a globus sensation in his esophagus, then had repeated forceful retching. Although his initial exam and most labs were normal, his white blood cell count was elevated.<br /><br />Emergency endoscopy revealed classic features of eosinophilic esophagitis (EoE), including concentric rings and linear furrows, along with a deep 15 cm linear esophageal tear extending toward the gastroesophageal junction. Because of concern for perforation, thoracic surgery was consulted. A CT scan showed a small pneumomediastinum but no frank perforation, and an esophagram confirmed no active leak, though esophageal emptying was delayed.<br /><br />The report emphasizes that EoE can predispose patients to spontaneous or procedure-related esophageal injury, especially when retching occurs. Perforation is rare but serious, occurring in about 2% of cases. Food impaction is strongly associated with EoE, with emerging data suggesting up to 50% of impaction cases may involve the disease. Since EoE is often unrecognized before presentation, endoscopy must be performed cautiously.<br /><br />The authors highlight the need for better pre-endoscopy strategies in adults presenting with food bolus obstruction, including possible roles for chest CT or swallowed topical corticosteroids, though evidence is not yet clear.<br /><br />Take-home points: maintain a high index of suspicion for undiagnosed EoE in food impaction; recognize symptoms and endoscopic findings early; and remember the IMPACT acronym for identifying at-risk eating behaviors: Imbibe, Modify, Prolong, Avoidance, Chew, Turn away food.

Asset Subtitle

Arman Bahmani

Meta Tag

Author List Arian Teymoorian, Arman Bahmani, Brian E. Yang, Sarah N. Matthews

Category Clinical Vignettes

Concept Eosinophilic Esophagitis

Concept Food Bolus Impaction

Concept Swallowing Impairment

Concept Endoscopic Findings

Concept Esophageal Injury

Distinguished Non-Finalist

Presenter Organization Loma Linda University Medical Center - Murrieta

Presenting Author Arman Bahmani

Track Adult

Keywords

eosinophilic esophagitis

food impaction

esophageal tear

pneumomediastinum

retching

endoscopy

esophageal perforation

globus sensation

linear furrows

concentric rings

Eosinophilic Esophagitis

Food Bolus Impaction

Swallowing Impairment

Endoscopic Findings

Esophageal Injury