We describe the case of a 20-month-old girl with a gastrostomy tube who presented with stridor, daily emesis, stertor, and mild neck retractions. Endoscopic and radiologic investigations revealed a dilated esophagus, an associated tracheal compression, and a paraesophageal hernia secondary to a slipped Nissen fundoplication. The patient underwent a revision fundoplication, and her stridor, stertor, and neck retractions subsided significantly. She tolerated tube feeding without emesis and was discharged home. We recommend a careful evaluation of fundoplication in patients who have undergone the procedure who present with stridor and frequent emesis. Esophageal dilation and associated tracheal compression should be considered in the differential diagnosis, and in such a case, revision of the gastric wrap should alleviate the problem.
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