Esophageal bolus obstruction
Eating roast dinner (lamb) overnight. Meat now feels "stuck" in upper oesophagus. Unable to swallow Coke or water. Continuously vomiting. No previous symptoms.
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Localized food bolus with associated fluid level in the mid esophagus at the level of the aortic arch. No other cause is evident. Esophagus is collapsed and empty more distally.
Food bolus obstruction is usually due to underlying esophageal pathology such as reflux stricture, carcinoma or mechanical stent for malignancy. Without underlying pathology the patient might be edentulous (i.e. unable to chew food adequately) or have impaired conscious state. In the past a barium study was the examination of choice but CT can now provide reasonable assessment prior to endoscopic removal. CT can also exclused perforation, i.e. the absence of extraluminal gas.