S4218 From Vaginal Laceration to Esophageal Stricture: Exploring the Path Between

Introduction: Esophageal strictures, commonly caused by intrinsic esophageal disease leading to luminal narrowing, often present as progressive dysphagia. Diagnosing and managing strictures can be challenging, particularly in medically complex patients. We present a 53-year-old woman who developed severe dysphagia following a complicated hospitalization for an infected vaginal laceration, ultimately found to have a distal esophageal stricture. Her case highlights a multifactorial pathogenesis involving mechanical, inflammatory, and infectious contributors. Case Description/Methods: The patient was initially hospitalized for 25 days due to sepsis from a traumatic vaginal laceration sustained during intercourse, complicated by intra-abdominal abscesses requiring laparotomy and drainage. Broad-spectrum antibiotics were completed during her stay, and she was discharged to a rehabilitation center. Over the following 2 weeks, she developed progressively worsening dysphagia, ultimately unable to tolerate solids. An esophagogastroduodenoscopy (EGD) at the rehabilitation center revealed a tight stricture in the distal esophagus, with failed scope advancement. Biopsies demonstrated ulceration, granulation tissue, and cytopathic changes suggestive of cytomegalovirus (CMV) infection, later confirmed by immunohistochemistry. She was transferred to our facility for further care. Repeat EGD showed severe distal stenosis successfully dilated with a 12-mm balloon. Follow-up biopsies revealed no evidence of CMV. A second dilation 12 days later confirmed absence of CMV infection. She was started on twice-daily pantoprazole with planned follow-up EGD. Discussion: The rapid development of a severe esophageal stricture within 30 days, in a previously healthy woman without gastroesophageal reflux disease, caustic ingestion, or medication-related esophagitis, is unusual. CMV esophagitis was initially suspected but later ruled out, raising questions about transient infection, sampling variability, or misdiagnosis. While CMV esophagitis can occur in immunocompetent and typically resolves with supportive care, its role here remains unclear. HIV testing was negative, and the patient had no notable immunocompromise. Acid hypersecretion related to physiologic stress may have contributed but cannot fully explain the stricture’s severity. This case emphasizes the need for thorough evaluation of dysphagia in complex patients. Timely diagnosis and endoscopic intervention are essential to optimize outcomes, even when pathogenesis is multifactorial or unclear.