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Acute pancreatitis — MCCQE Part 1 MCQ

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HardAbdominal PainAcute pancreatitisMCCQE Part 1

A 32-year-old man with intermittent solid-food dysphagia develops sudden substernal discomfort while eating steak. Four hours later he is drooling and cannot swallow water or his own saliva. He is breathing comfortably with no crepitus. What is the best next management?

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Correct answer: A — Arrange urgent endoscopic removal with airway planning and obtain oesophageal biopsies when safe

Inability to swallow saliva with drooling indicates complete oesophageal obstruction, even though respiratory status and vital signs remain stable. This requires urgent endoscopic relief because delay increases aspiration, mucosal injury, and perforation risk. Keep him nil by mouth, assess and protect the airway during procedural planning, and involve endoscopy urgently. Blind nasogastric passage and contrast swallowing can worsen risk or delay definitive care. Pharmacologic or carbonated-drink strategies must not postpone endoscopy in complete obstruction. His preceding intermittent solid-food dysphagia makes an underlying structural disorder or eosinophilic oesophagitis likely. The Canadian consensus strongly encourages oesophageal biopsies at the removal endoscopy when this can be done safely, followed by appropriate gastroenterology assessment. Routine outpatient treatment alone is inappropriate while the bolus remains impacted.

Reference: Canadian eosinophilic oesophagitis Delphi consensus, 2025: https://pmc.ncbi.nlm.nih.gov/articles/PMC12595650/