Mobile upper oesophageal lipoma causing airway obstruction

A previously well man presented with high dysphagia secondary to an upper oesophageal lipoma, which periodically prolapsed retrograde into the hypopharynx and supraglottis. When confined to the oesophagus, the lesion caused mild dysphagia only and could not be identified on oesophagoscopy. However, supraglottic herniation of the lesion led to acute aphagia and airway obstruction, eventually necessitating a local anaesthetic tracheostomy. The curious and elusive nature of this lipoma led to delays in definitive surgical excision, which was eventually performed via an external approach oesophagotomy, with complete resolution of swallowing function. The case highlights the difficulty in the management of mobile submucosal upper oesophageal lipomas, whose fluctuating symptomology can lead to delayed diagnosis but also intermittent life-threatening laryngeal obstruction. Surgical management requires confidence in proceeding to transcervical oesophagotomy when endoscopic management has failed.