Steakhouse Syndrome Case Report

Steakhouse Syndrome: A Case Report

Keiichiro Kita, MD1), PhD, Masahiro Nagatsuma, MD2), Haruka Fujinami, MD, PhD3), Seiji Yamashiro, MD, MS1)

1) Department ofGeneral Medicine, Toyama University Hospital 2) Department ofEmergency and Disaster Medicine, Toyama University Hospital 3) Third department ofInternal Meidicine（Hematology and ), Toyama University

Acute food impaction of the is a medical emergency caused by an ingested foreign body. Since the most common obstructing bolus is poorly chewed meat（often following beer drinking), it is often called6steakhouse syndrome7or6backyard barbecue syndrome.71 In this article we present a typical case ofthis relatively unknown syndrome. Written permission was obtained from the patient for publication.

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Case Report that had been performed two A 68-year-old male with liver （ years prior to this presentation. B virus positive）and Type 2 diabetes mellitus presented to our emergency room with swallowing Discussion difficulty. He had been vomiting after every meal for Steakhouse syndrome is usually associated with the past two days. On physical examination, his mechanical or functional diseases that narrow the cardiovascular and respiratory status was unremark- lumen ofthe esophagus. Various diseases can be able. There were no signs ofintestinal obstruction in underlying conditions. Esophageal carcinoma（pri- an abdominal X-ray. A chest CT showed something mary or metastatic), carcinoma ofthe gastroesopha- stuck in the lower part ofthe esophagus（ Figure 1). geal junction, stricture（peptic or post therapeutic), On upper gastrointestinal endoscopy, a beefbolus diverticulum, hiatal and Schatzki rings2 are the obstructing the esophagus was found and removed main mechanical causes. As functional causes, achala- with retrieval basket forceps（Figure 2a). The re- sia, nutcracker esophagus, and esophageal spasm3,4 moved meat bolus was about six centimeters in length are important differential diagnoses. Recently, eosino- （Figure 2b). His lower esophagus was slightly philic has also been noted as a hidden narrowed due to endoscopic ligation therapy for condition leading to esophageal food impaction.5 In one

Author for Corresponding : Keiichiro Kita, MD1), PhD, Department ofGeneral Medicine, Toyama University Hospital, 2630, Sugitani, Toyama, 930-0194 E-mail: [email protected] Received for publication 16 February 2011 and accepted 17 August 2011

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Figure 1. Chest CT showed something stuck in Figure 2a. A meat bolus obstructing the the lower part of the esophagus. esophagus.

Figure 2b. The removed meat bolus. perforation, pneumomediatinum and aspiration also should be ruled out by chest X-ray examinations. Although the prognosis is good after the removal of the bolus, every patient should receive a full diagnostic workup, because many cases have underly- ing diseases that should be treated.1

References 1 Stadler J.; Hölscher A. H.; Feussner H.; Ditter J.; Siewert J. R. The6steakhouse syndrome7. Primary and definitive diagnosis and therapy. Surg Endosc. 1989, Vol. 3, p. 195-198. 2 Belafsky P. C.; Postma G. N.; Koufman J. A. ʻSteakhouse syndromeʼ in a man with a lower small series from Germany, the mean age of such esophageal ring and a . Ear Nose Throat cases was 60, and it was predominantly seen in men.1 J. 2003, vol. 82, p. 102. A characteristic history is the most important clue 3 DiPallma J. A.; Brady C. E. 3rd. Steakhouse spasm. to the diagnosis. The patient usually complains of J Clin Gastroenterol. 1987, vol. 9, p. 274-278. abrupt difficulty in swallowing further liquids or solids 4 Chae H. S.; Lee T. K.; Kim Y. W.; Lee C. D.; Kim S. while eating. Many authors recommend esophagogas- S.; HanS. W. et al. Two cases ofsteakhouse syndrome troendoscopy as an initial diagnostic and therapeutic associated with nutcracker esophagus. Dis procedure for food impaction. Esophagus. 2002, vol. 15, p. 330-333. However, an electrocardiogram should be per- 5 Kerlin P.; Jones D.; Remedios M; Campbell C. formed, because some of these patients develop Prevalence ofeosinophilic esophagitis in adults with substernal , mimicking ischemic heart food bolus obstrucion of the esophagus. J Clin disease.1 Other critical conditions, such as esophageal Gastroenterol. 2007, vol. 41, p. 356-361.

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