Esophageal Bleeding and Radiational Esophagitis Presenting as Acute Gastroesophageal Junction Obstruction

Acute gastroesophageal junction (GEJ) obstruction is an uncommon condition which can raise concern for malignancy. We report a case of spontaneous esophageal bleeding of a patient on chronic anticoagulation who received radiation therapy 4 months prior, presenting with sudden onset intractable nausea, vomiting and abdominal pain. Imaging demonstrated marked esophageal dilation with distal obstruction. Endoscopy revealed a large friable, near-obstructing esophageal mass with extensive clot burden. Repeated biopsies showed necrotic debris, inflammation, and fungal elements without malignancy. Endoscopic removal led to complete symptom resolution.