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Images of Memorable Cases: Case 71

Module by: Herbert L. Fred, MD, Hendrik A. van Dijk

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Case_71-pres1-1.jpg Case_71-pres1-2.jpg

Chest radiographs of a 31-year-old medical resident with recurrent bouts of hiccupping, associated at times with mild epigastric distress.

71. Colon interposition

The chest radiographs show a gas-distended, lobulated, cystic structure with several air-fluid levels, filling the precordial space from the diaphragm to the thoracic inlet. In addition, the lateral aspects of three upper ribs on the right are deformed. These findings together are diagnostic of a segment of colon surgically placed in the chest. A barium swallow shows the intrathoracic segment of colon with a few diverticula (image below).

Case_71-diag1-1.jpg

This patient had a congenital tracheoesophageal fistula treated at birth with gastrostomy and at age two with colon interposition between her cervical esophagus and her stomach. She has done remarkably well ever since.

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