The Variable Roentgenographic Appearance of Invagination of the Esophagus
INVAGINATION of the esophagus is a physiologic process in which the distal portion of the esophagus moves downward into the gastric cardia. Invagination is usually associated with a small hiatus hernia that on roentgenograms creates a filling defect that has been likened to a “jack-in-the-pulpit” or “Saturn ring.” Occasionally the esophagus invaginates into the gastric cardia below the diaphragm, thus creating a large cup-shaped filling defect. Esophageal invagination is commonly associated with dysphagia1 and this is of some clinical significance. Complications such as esophagitis and obstruction have seldom been reported as related to this disorder.1,2 The transient nature of the phenomenon probably accounts for its infrequent recognition and reporting in the literature.
The exact mechanism of invagination of the esophagus into the stomach is still not resolved. Sliding of the esophageal mucosa into a hiatus hernia is a current and logical explanation for the radiographic appearance in most cases. Invagination may be minimal or extend deeply into the cardia. Minimal invagination will often be demonstrated only when the patient is prone, with compression or straining maneuvers. Extensive invagination is quite readily demonstrable, and may be seen when the patient is supine or prone, without special maneuvers to increase intraabdominal pressure.
The 13 cases that are the basis of this report were identified from 270 consecutive cases of sliding and 11 fixed hiatus hernias seen at the Cleveland Clinic during the last two years. All patients underwent fluoroscopic examination by the author; views were taken in upright, prone, and supine positions. . .