Achalasia of the Esophagus vs. Congenital Stenosis of the Esophagus
Left picture: The diagnosis is an achalasia of the esophagus which may occur already in infancy. Right picture: In this case a congenital intrinsic stenosis of the esophagus is present. Both patients have infrequent pathologies. But in both, a delayed hypertrophic pyloric stenosis must be considered too, and other causes of a voiding disorder of the stomach must be excluded.
In both older infants feeding is difficult, mainly after the transition from liquid to semi-solid feeds, which have been brought up continuously during feeding, but had no acid odour. The upper gastrointestinal contrast study that was subsequently performed showed a dilatation of the upper two thirds of the esophagus in both patients. Left picture: The dilated esophagus changes abruptly to a fine, barely visible structure. Right picture: The same segment of the esophagus as in the contralateral picture has a regular shape; but the continuity from the middle to the lower third of the esophagus is abruptly interrupted except for a fine communication. Right picture: Retrospectively, the disturbances in feeding this patient can be dated back as far as to the first trimenon. Left picture: In this patient, it is impossible to date back analogous disturbances of feeding as it is with the contalateral patient.