Is an X-ray a Useful Test for Esophageal Food Boluses? A Case Report.

This is a case supporting the use of plain film radiography in a patient presenting with symptoms suggestive of an esophageal food bolus impaction. The patient presented with a foreign body sensation in her chest after eating chicken the night before. She complained of nausea after oral intake. She had an emergency department (ED) visit with a plain film of the chest and chest pain work up the night prior to presentation. On her return visit to the ED, the patient appeared to tolerate oral intake, but a plain film demonstrated a fluid level in the esophagus with proximal dilation. In light of this plain film finding, the patient underwent emergent endoscopy with prompt removal of the food bolus and diagnosis of the underlying etiology. This case report suggests that if a patient is able to tolerate a small volume of oral liquids yet remains symptomatic, a plain film of the chest may be helpful in diagnosis of an obstruction with a radiolucent food bolus. Topics: Plain film, esophageal food bolus impaction, esophagitis, esophageal dysmotility, obstruction.

Racial disparities in the use of laparoscopic surgery to treat colonic diverticulitis Are not fully explained by socioeconomics or disease complexity.

BACKGROUND: Several studies have demonstrated favorable outcomes for laparoscopic surgery over open surgery for the treatment of diverticular disease. This study was designed to analyze the relationship between race, socioeconomic status and the use of laparoscopy to address diverticulitis. METHODS: A retrospective analysis of 53,054 diverticulitis admissions was performed using data from the 2009-2013 National Inpatient Sample (NIS). The primary outcome was the use of laparoscopic versus open colectomy. Bivariate analysis and multivariable logistic regression were used to determine the raw and adjusted odds by race, insurance status, and median household income. RESULTS: Overall, 41.6% of colectomies involved the use of laparoscopy. Black patients were 19% less likely than White patients to undergo laparoscopic surgery. Hispanic patients were no more or less likely to undergo laparoscopic colectomy. Lacking private insurance was a strong predictor of undergoing open surgery. Lower income patients were 33% less likely to receive minimally invasive colectomies. CONCLUSIONS: These results demonstrate disparities in surgical treatment. Further research is warranted to understand and ameliorate treatment differences which can contribute to outcome disparities.