Congenital esophageal stenosis in an eight-year-old boy: a case report

Congenital esophageal stenosis is one of the rarest congenital anomalies in children, with an incidence of approximately 1 in 25,000 to 50,000 live births. Esophagography is the primary diagnostic tool used for its identification. An eight-year-old boy had dysphagia to solid foods since the age of six months. In the two days prior to his presentation to the hospital he developed persistent vomiting even after drinking water. He was malnourished, weak and had a weight of 18 kg. A contrast swallow study was initially interpreted as a caustic injury, but no history of ingestion was found. Due to the persistence of symptoms after two balloon dilatations done two weeks apart, congenital esophageal stenosis was suspected. The patient was taken to the operative room for an exploratory thoracotomy through the right side. We dissected the esophagus and found a fibrotic stenotic segment measuring 2 cm in length. We resected the segment and proceeded with an end-to-end anastomosis using interrupted PDS 3.0 sutures. A contrast swallow study done on postoperative day 5 confirmed no esophageal leak. We initiated clear liquid diet that day and advanced to soft diet the following day. He was discharged home on the 6th postoperative day. During the first year after the operation, we saw him monthly and confirmed that he remained asymptomatic. By the end of the first year his weight was 25 kg, and he continued to be without symptoms. Congenital esophageal stenosis must be suspected in children who have a long-standing history of dysphagia. • Congenital esophageal stenosis is an extremely rare congenital esophageal anomaly. • Usually the mean age of diagnosis is in infancy. • Diagnosis is challenging and often confused with achalasia or acquired esophageal strictures. • Treatment options depend on the type, which is dilatation or surgery. • Limited access to diagnostic resources in Afghanistan delayed accurate diagnosis.