Mega esophagus differential diagnosis and therapy
Hoellwarth, M.; Graf, D.; Fotter, R.
Zeitschrift fuer Kinderchirurgie 32(1): 37-46
Functional hindrances in the esophageal tract are particularly recognized in achalasia, which occurs in less than 5% of children. The megaesophagus accompanying massive gastroesophageal reflux can also be a consequence of functional disturbances. Peptic stenosis of the esophagus usually causes dilatation of this organ. Other organic stenoses are just as rare, whether they are congenital membranous or fibromuscular stenoses, or occur as secondary narrowing of the esophagus, following accidental acid-burns. Treatment of choice in achalasia is cardiomyotomy with insertion of a fundus patch. Gastroesophageal reflux is usually treated conservatively at first. Operation and fundoplication is indicated only when this treatment is unsuccessful, or primarily in peptic stenosis. In congenital membranous stenosis or acid-burn stenosis, forceful treatment with bougies usually attains the desired ends. Congenital fibromuscular narrowing generally requires operative resection.