As its name suggests, hairy esophagus is a rare manifestation of skin grafting for pharyngoesophageal reconstructive surgery that presents with hair follicles inside the esophagus.
Fundoplication
Fundoplications constitute a variety of surgical procedures that are aimed at preventing intractable GERD. The fundamental principle is to tighten or compress the lower esophageal sphinc- ter by “wrapping” a portion of the proximal stomach around the lower esophagus, thereby preventing gastric contents from
refluxing up into the esophagus. The most common procedure is the Nissen* fundoplication, which is a complete 360-degree wrap (others are partial wraps of approximately 240 to 270 degrees). Complications usually arise because the wrap is too tight or too loose. In the former, there is delayed esophageal emptying, which can be observed at UGI examination, or there can be free reflux and a widened GE junction if the wrap is too loose. Wraps become too loose when the sutures become dis- rupted and the wrap begins to unfold itself. The wrap can also *Rudolf Nissen (1896-1981), German surgeon.
Figure 1-85. Barium swallow in a 74-year-old man with recurrent esophageal cancer and stent placement to relieve dysphagia. There is irregularity of the esophageal lumen (arrow), but contrast passes through to the stomach.
Figure 1-86. UGI swallow in a 44-year-old woman with a normal Nissen fundoplication. There is a smooth tapering to the lower esophagus. The “wrap” surrounds the lower esophagus (arrow).
Figure 1-87. UGI swallow in a 51-year-old woman with a fundal filling defect (arrows) due a normal Nissen fundoplication.
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slide caudally to constrict the middle aspect of the stomach (similar to an hourglass appearance). Conversely, the wrap may herniate into the chest.
The normal appearances with UGI examination demonstrate a smooth tapering of the lower esophagus as it passes through the wrap, which itself may be outlined by barium (Fig. 1-86). Between the esophagus and the wrap is a radiolucent circular band of the constricting gastric wall around the esophagus (Fig. 1-87). At CT, there is a soft tissue mass-like density around the lower esophagus for a few centimeters. Complications, however, are best evaluated by UGI series because CT will generally be unable to determine whether the wrap is too loose or too tight. If the wrap is too tight, the esophagus may be distended, and if it is too loose, the wrap can be seen at barium swallow unfolding and GERD will return (Figs. 1-88 and 1-89). Nonwrap complications are common to most other surgical procedures and include hem- orrhage, fluid collections, and abscess in the chest or abdomen due to leaks.
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