Iatrogenic Esophageal Mucosal Tear Following Upper Endoscopy in Lactating Patient with Chronic Dysphagia

Case at a Glance

A 20-year-old postpartum female presented with severe odynophagia following an upper endoscopy procedure that resulted in an esophageal mucosal tear. The patient has a history of progressive dysphagia and is currently breastfeeding a 6-month-old infant.

Patient's Story

The patient reported lifelong dysphagia that had progressively worsened over the past two years. She underwent her first upper endoscopy two years prior, which was inconclusive for a definitive diagnosis. A second endoscopy was scheduled with planned dilation therapy. During the procedure, an esophageal mucosal tear occurred, preventing the planned dilation. Post-procedure, the patient developed severe pain with swallowing any solids or liquids, including water, soup, and milkshakes. Her primary concern was maintaining adequate nutrition and hydration for continued breastfeeding of her 6-month-old infant who relies predominantly on breast milk.

Initial Assessment

Physical examination revealed a 20-year-old female weighing approximately 150 pounds, appearing uncomfortable but stable. The patient demonstrated significant pain with attempts at oral intake. Endoscopic images showed linear mucosal tears consistent with the procedural complication. The patient was awaiting biopsy results from tissue obtained during the endoscopy.

The Diagnostic Journey

The patient's history of progressive dysphagia beginning in childhood, combined with endoscopic findings and the characteristic pattern of mucosal tearing during endoscopy, suggested eosinophilic esophagitis (EoE). The mucosal tear pattern observed was consistent with the friable esophageal mucosa typical of EoE. Histopathological examination was pending to confirm the suspected diagnosis.

Final Diagnosis

Suspected eosinophilic esophagitis with iatrogenic esophageal mucosal tear secondary to upper endoscopy. Final diagnosis pending histopathological confirmation from esophageal biopsies.

Treatment Plan

Conservative management was initiated with proton pump inhibitor therapy to reduce acid exposure and promote mucosal healing. Sucralfate suspension was recommended for mucosal protection. The patient was advised to consume only soft, bland foods and avoid acidic or spicy items. Given her breastfeeding status, medication choices were carefully considered for safety. Pain management focused on topical anesthetics and positioning during feeding. The patient was counseled on the option of supplemental formula feeding if oral intake remained severely limited.

Outcome and Follow-up

The patient was advised to monitor for signs of complications such as fever, chest pain, or worsening dysphagia that might indicate perforation or infection. Close follow-up was arranged to assess healing progress and review biopsy results. Nutritional counseling was provided to ensure adequate maternal nutrition for continued breastfeeding. The patient was educated about EoE management strategies pending diagnostic confirmation.