Benign Esophageal Obstruction Due to Radiation Esophagitis

A 29-year-old man was given a diagnosis as having primary mediastinal large B-cell lymphoma and received R-CHOP chemotherapy followed by radiation therapy with a total dose of 30 Gy (to the upper mediastinum, bilateral irradiation of 28 Gy and oblique irradiation of 2 Gy) after the chemotherapy. He suffered dysphasia 2 months after the irradiation. Upper gastrointestinal endoscopy showed total obstruction of the upper thoracic esophagus, therefore, endoscopic dilation was impossible. Because the patient’s nutritional status was very poor, and he was unable to eat anything by mouth, we first performed tube enterostomy to improve his nutritional status. After enteral feeding for 1.5 months, we then performed esophagectomy. Taking into account the pathological findings and the clinical course, we thought the cause of the esophageal obstruction was radiation esophagitis. The postoperative course was uneventful, and he was discharged 20 days after the esophagectomy. We often experience radiation esophagitis, however, only a few cases result in esophageal obstruction. In the case of esophageal obstruction due to radiation esophagitis, for which it is thought impossible to perform endoscopic dilation, and in which the possibility of malignant disease cannot be ruled out, we need to perform esophagectomy, which can also serve as accurate diagnosis.