Impaction of a large food bolus in the esophagus may be associated with sudden death.

Clinical features:

(1) sudden cardiac death

(2) large food bolus impacted in the esophagus

(3) underlying esophageal disorder

(4) underlying cardiovascular disease

(5) variable minor degrees of aspiration


Possible mechanisms:

(1) tracheal compression if impaction is in proximal esophagus

(2) vagal stimulation with bradycardia or cardiac arrhythmias

(3) stress response with tachycardia and hypertension


Esophageal disorders may include:

(1) eosinophilic esophagitis

(2) gastric operation for morbid obesity

(3) stricture

(4) other cause of dysmotility


A less sudden death may be associated with esophageal perforation.


Differential diagnosis:

(1) cafe coronary (obstruction of airway by food bolus)

(2) regurgitation of food from the stomach into the esophagus at death

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