Regurgitation of Undigested Food: What is Your Diagnosis?

Abstract

An otherwise healthy 28-year-old male presented with a 10-year history of bolus sensation after eating and occasional regurgitation of undigested food. Symptoms were getting worse in the last two years. The episodes occurred right after eating, especially with solid boluses, when he leaned forward or contracted the pharyngeal muscles, a maneuver that he learned useful to clear the food bolus that was not properly swallowed. He also presented occasional episodes suggestive of aspiration, evidenced by cough while eating and one episode of choking but no past history of bronchitis or pneumonia. He denied chronic throat clearing, nocturnal coughing, pain, dyspnea, or weight loss. Findings on physical examination were within normal limits. Fiberoptic laryngoscopy showed slightly enlarged lingual tonsils hampering the visualization of the valleculae, but was otherwise unremarkable. There was no evident pooling, penetration, or aspiration of saliva (Fig. 1). CT scan of the neck suggested bilateral mixed (internal and external) laryngoceles with slight increase with Valsalva maneuver (Fig. 2a, b), but the diagnosis was inconsistent with clinical symptoms and laryngoscopic findings.