1
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Jiao Y, Sikong YH, Zhang AJ, Zuo XL, Gao PY, Ren QG, Li RY. Submucosal esophageal abscess evolving into intramural submucosal dissection: A case report. World J Clin Cases 2022; 10:10695-10700. [PMID: 36312467 PMCID: PMC9602247 DOI: 10.12998/wjcc.v10.i29.10695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/28/2022] [Accepted: 08/31/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Here we report a rare case of submucosal esophageal abscess evolving into intramural submucosal dissection.
CASE SUMMARY An 80-year-old woman was admitted to our emergency department with a chief complaint of dysphagia and fever. Laboratory tests showed mild leukocytosis and elevated C-reactive protein level. Computed tomography showed thickening of the esophageal wall. Upper endoscopy showed a laceration of the esophageal mucosa and a submucosal mass. Spontaneous drainage occurred, and we could see purulent exudate from the crevasse. We closed the laceration with endoscopic clips. The patient did not remember swallowing a foreign body; however, she ate crabs before the symptoms occurred. We prescribed the patient with antibiotic, and the symptoms were gradually relieved. Two months later, upper endoscopy showed that the laceration was healed, and the submucosal abscess disappeared. However, intramural esophageal dissection was formed. We performed endoscopic incision of the septum using dual-knife effectively.
CONCLUSION In conclusion, we are the first to report the case of esophageal submucosal abscess evolving into intramural esophageal dissection. The significance of this case lies in clear presentation of the evolution process between two disorders. In addition, we recommend that endoscopic incision be considered as one of the routine therapeutic modalities of intramural esophageal dissection.
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Affiliation(s)
- Yang Jiao
- Department of General Surgery, Shandong University of Qilu Hospital (Qingdao), Qingdao 266000, Shandong Province, China
| | - Yin-He Sikong
- Department of Gastroenterology, Shandong University of Qilu Hospital (Qingdao), Qingdao 266000, Shandong Province, China
| | - Ai-Jun Zhang
- Department of Gastroenterology, Shandong University of Qilu Hospital (Qingdao), Qingdao 266000, Shandong Province, China
| | - Xiu-Li Zuo
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan 250000, Shandong Province, China
| | - Pu-Yue Gao
- Department of Gastroenterology, Shandong University of Qilu Hospital (Qingdao), Qingdao 266000, Shandong Province, China
| | - Qing-Guo Ren
- Department of Radiology, Shandong University of Qilu Hospital, Shandong University, Qingdao 266000, Shandong Province, China
| | - Ru-Yuan Li
- Department of Gastroenterology, Shandong University of Qilu Hospital (Qingdao), Qingdao 266000, Shandong Province, China
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2
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Hu JW, Zhao Q, Hu CY, Wu J, Lv XY, Jin XH. Rare spontaneous extensive annular intramural esophageal dissection with endoscopic treatment: A case report. World J Clin Cases 2021; 9:11467-11474. [PMID: 35071579 PMCID: PMC8717524 DOI: 10.12998/wjcc.v9.i36.11467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/17/2021] [Accepted: 11/15/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Intramural esophageal dissection (IED) is a rare disease that should be considered in patients with chest pain, dysphagia, and hematemesis. Although it occurs most frequently in older adult women with impaired coagulation or as a sequela of endoscopy, the incidence of spontaneous IED without an obvious causative agent has risen gradually.
CASE SUMMARY This report describes a case of extensive annular IED in a 75-year-old male patient who presented with dysphagia for the past month. Esophageal barium meal radiography revealed slow passage of diluted iohexol through the esophagus after swallowing, prominent luminal dilation, obstruction of the lower segment with only a small amount of contrast medium entering the gastric cavity, and no obvious extravasation. Gastroscopy revealed smooth esophageal mucosa; several esophageal mucosal bridges and webbed mucosa were observed approximately 22 cm from the incisor. The mucosal surface was occasionally rough and uneven, and the length of the esophageal mucosal defect exceeded 10 cm. The anatomy was considered to be annular because the mucosal bridge connecting the proximal and distal tube was not attached to the surrounding myotubes. The final diagnosis was spontaneous extensive annular IED. We treated the patient successfully using endoscopic esophagotomy, which completely relieved the symptoms without complications.
CONCLUSION Spontaneous annular IED can be treated successfully by endoscopic resection of the mucosal septum between the true and false lumen.
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Affiliation(s)
- Jian-Wen Hu
- Department of Gastroenterology, Dongyang People's Hospital, Dongyang 322100, Zhejiang Province, China
| | - Qian Zhao
- Department of Gastroenterology, Dongyang People's Hospital, Dongyang 322100, Zhejiang Province, China
| | - Chi-Yv Hu
- Department of Gastroenterology, Dongyang People's Hospital, Dongyang 322100, Zhejiang Province, China
| | - Jie Wu
- Department of Gastroenterology, Dongyang People's Hospital, Dongyang 322100, Zhejiang Province, China
| | - Xiang-Yin Lv
- Department of Gastroenterology, Dongyang People's Hospital, Dongyang 322100, Zhejiang Province, China
| | - Xiang-Hong Jin
- Department of Gastroenterology, Dongyang People's Hospital, Dongyang 322100, Zhejiang Province, China
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3
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Anand S. Circumferential intramural esophageal dissection with large mucosal defect. Clin J Gastroenterol 2020; 13:1-3. [PMID: 32222949 DOI: 10.1007/s12328-020-01117-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 03/16/2020] [Indexed: 12/15/2022]
Abstract
Intramural esophageal dissection (IED) is an uncommon entity characterized by mucosal rupture creating a false lumen. It usually develops following endoscopy or in old patients with bleeding tendencies and spontaneous presentation possesses diagnostic dilemma. Managing partial IED is simpler than circumferential IED. Due to rarity of presentation, management is not standardized. We report circumferential IED in a young patient and challenges faced during diagnosis and management.
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Affiliation(s)
- Santhosh Anand
- Department of Surgical Gastroenterology, Dharan Multi Speciality Hospital, Tamil Nadu, Salem, India.
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4
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Kumar S, Sakthivel MK, Bosemani T. Intramural Esophageal Abscess Complicated with Pleural Fistula: A Case Report. Cureus 2020; 12:e6846. [PMID: 32181081 PMCID: PMC7053692 DOI: 10.7759/cureus.6846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Intramural esophageal abscess is a rare entity caused by mucosal injury to the esophagus but without transmural perforation. The mucosal disruption provides access to the intraluminal infectious contents to traverse into the loose submucosal tissue, resulting in an intramural abscess. It is important to be well-versed in the clinical and imaging findings of this pathology in order to make a timely diagnosis. Here, we present a case of intramural esophageal abscess complicated with a pleural fistula with a focus on the radiological features of this rare entity. To our knowledge, this is the first time that an esophageal intramural abscess complicated with pleural fistula is discussed in peer-reviewed literature.
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5
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Chen PH, Yang SM, Huang PM. Management of Patients With Circumferential Intramural Esophageal Dissection. Ann Thorac Surg 2019; 108:e55-e56. [PMID: 30880138 DOI: 10.1016/j.athoracsur.2019.01.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 01/20/2019] [Accepted: 01/29/2019] [Indexed: 11/17/2022]
Abstract
A novel minimally invasive endoscopic drainage technique using a double-tube system improves the feasibility and safety of conservative treatment in spontaneous esophageal intramural dissection (EID). Two patients with spontaneous EID underwent double-tube system placement through esophagogastroduodenoscopy. One tube was inserted into the submucosal layer with continuous suction, and another nasoduodenal tube was simultaneously inserted for enteral nutritional support. Given the ease of placement and the success of this simple double-tube system method, this technique may provide a new, low-risk, and cost-effective treatment modality for patients with EID.
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Affiliation(s)
- Pei-Hsing Chen
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Shun-Mao Yang
- Division of Thoracic Surgery, Department of Surgery, Hsin-Chu Branch of National Taiwan University Hospital, Hsin-Chu City, Taiwan
| | - Pei-Ming Huang
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
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6
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Abstract
Introduction: Spontaneous esophageal dissection is a rare disorder of the esophagus. Case Description: We present what is believed to be the first reported case of recurrent esophageal dissection in a previously healthy 33-year-old man with chronic eosinophilic esophagitis. He had two episodes of spontaneous dissection of the midesophagus separated by a 5-month interval. Both episodes responded to treatment with endoscopic intervention. He has remained free of additional recurrences after definitive endoscopic therapy and oral steroid therapy. A complete description of the case, relevant radiologic imaging, and a review of the relevant literature are provided. Discussion: Endoscopic therapy is an option for the management of recurrent esophageal dissection.
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Affiliation(s)
- Nicholas A Stephens
- Department of Surgery, University of Texas Medical School at Houston, Houston, TX, USA
| | - Shinil K Shah
- Department of Surgery, University of Texas Medical School at Houston, 6431 Fannin Street, Houston, TX 77030, USA; Michael E. DeBakey Institute for Comparative Cardiovascular Science and Biomedical Devices, Texas A & M University, College Station, TX, USA.
| | - Peter A Walker
- Department of Surgery, University of Texas Medical School at Houston, Houston, TX, USA
| | | | - Isaac Raijman
- Digestive Associates of Houston, PA, Houston, TX, USA
| | - Kamal Khalil
- Department of Cardiothoracic and Vascular Surgery, University of Texas Medical School at Houston, Houston, TX, USA
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7
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Ko RE, Jung WS, Lee YC, Choi SH, Seo SY. [Management of Intramural Esophageal Dissection with Gastric Feeding Tube in an Alcoholic-hepatitis Patient]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2016; 67:35-8. [PMID: 26809630 DOI: 10.4166/kjg.2016.67.1.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Intramural esophageal dissection is a rare but clinically important condition in the field of gastroenterology. Classically, intramural esophageal dissection rarely occurs in patients who are anticoagulated or have poor medical condition, and its clinical presentation may include chest pain, dysphagia and hematemesis. Herein, we present a case of intramural esophageal dissection in an alcoholic hepatitis patient that was diagnosed by endoscopy and successfully treated with conservative management.
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Affiliation(s)
- Ryoung Eun Ko
- Department of Internal Medicine and Research Institute of Clinical Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Won Sik Jung
- Department of Internal Medicine and Research Institute of Clinical Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Yoon Chae Lee
- Department of Internal Medicine and Research Institute of Clinical Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Sung Hoon Choi
- Department of Internal Medicine and Research Institute of Clinical Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Seung Young Seo
- Department of Internal Medicine and Research Institute of Clinical Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Korea
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8
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Jeong ES, Kim MJ, Yoo SH, Kim DH, Jung JS, Koo NH, Chang SH. Intramural hematoma of the esophagus after endoscopic pinch biopsy. Clin Endosc 2012; 45:417-20. [PMID: 23251891 PMCID: PMC3521945 DOI: 10.5946/ce.2012.45.4.417] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Revised: 07/16/2012] [Accepted: 07/16/2012] [Indexed: 12/22/2022] Open
Abstract
Intramural hematoma of the esophagus (IHE) is an uncommon form of esophageal injury, which may be an intermediate of mucosal tear (Mallory-Weiss syndrome) or transmural rupture (Boerhaave's syndrome). To date, the pathogenesis of IHE has not been well documented. IHE may occur within the submucosal layer of the esophagus following dissection of the mucosa. The most commonly presented symptoms are sudden retrosternal pain, dysphagia and hematemesis. The disorder can occur spontaneously or secondarily to trauma. In this report, we present a case of IHE which occurred after endoscopic biopsy and was recovered following conservative management in a patient who was taking long-term aspirin medication.
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Affiliation(s)
- Eun Soo Jeong
- Division of Gastroenterology, Department of Internal Medicine, KEPCO Medical Center, Seoul, Korea
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9
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Predina JD, Anolik RB, Judy B, Akers S, Freiman D, Ahmad N, Singhal S. Intramural esophageal dissection in a young man with eosinophilic esophagitis. Ann Thorac Cardiovasc Surg 2011; 18:31-5. [PMID: 21959190 DOI: 10.5761/atcs.cr.10.01629] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Intramural esophageal dissection is a rare disorder that should be considered in patients presenting with chest pain, dysphagia, and hematemesis. Although most commonly occurring in elderly women with impaired coagulation, esophageal dissection has also been observed in other demographics including in those with eosinophilic esophagitis. In our report, we present the case of a 19-year-old man who was found to have an intramural esophageal dissection in the setting of undiagnosed eosinophilic esophagitis. There have been multiple, proposed management strategies; however, we implemented a nonoperative approach and obtained successful results. Intramural esophageal dissection is an important diagnosis for thoracic surgeons to be aware of as these patients often present as surgical emergencies, but often do not require an acute surgical intervention.
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Affiliation(s)
- Jarrod D Predina
- Division of Thoracic Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
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10
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Benatta MA, Grimaud JC, Kaci M, Desjeux A, Baghdadi M, Loumi A. Intramural esophageal dissection due to pharyngeal abscess treated by endoscopic esophageal transection: a case report. ACTA ACUST UNITED AC 2010; 34:329-31. [PMID: 20510559 DOI: 10.1016/j.gcb.2010.04.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Revised: 04/14/2010] [Accepted: 04/14/2010] [Indexed: 02/08/2023]
Abstract
Intramural esophageal dissection is a rare disorder characterized by extensive laceration between the mucosal and submucosal layers of the esophageal wall, but without perforation. The etiology of intramural dissection of the esophagus remains uncertain. Conservative management is usually considered adequate. Only one case of circumferential intramural esophageal dissection has been reported previously. We report here on a case due to an infectious cause (paryngeal abscess) that is also an unusual example of circumferential intramural esophageal dissection, which was then treated by endoscopic transection of the true internal esophageal wall and bougienage dilation.
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Affiliation(s)
- M A Benatta
- Universitary Military Hospital Oran, Algeria.
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11
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12
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Kwon CI, Ko KH, Kim HY, Hong SP, Hwang SG, Park PW, Rim KS. Bowel obstruction caused by an intramural duodenal hematoma: a case report of endoscopic incision and drainage. J Korean Med Sci 2009; 24:179-83. [PMID: 19270837 PMCID: PMC2650968 DOI: 10.3346/jkms.2009.24.1.179] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2007] [Accepted: 01/29/2008] [Indexed: 12/12/2022] Open
Abstract
Complications associated with an intramural hematoma of the bowel, is a relatively unusual condition. Most intramural hematomas resolve spontaneously with conservative treatment and the patient prognosis is good. However, if the symptoms are not resolved or the condition persists, surgical intervention may be necessary. Here we describe internal incision and drainage by endoscopy for the treatment of an intramural hematoma of the duodenum. A 63-yr-old woman was admitted to the hospital with hematemesis. The esophagogastroduodenoscopy (EGD) showed active ulcer bleeding at the distal portion of duodenal bulb. A total of 10 mL of 0.2% epinephrine and 2 mL of fibrin glue were injected locally. The patient developed diffuse abdominal pain and projectile vomiting three days after the endoscopic treatment. An abdominal computed tomography revealed a very large hematoma at the lateral duodenal wall, approximately 10 x 5 cm in diameter. Follow-up EGD was performed showing complete luminal obstruction at the second portion of the duodenum caused by an intramural hematoma. The patient's condition was not improved with conservative treatment. Therefore, 21 days after admission, endoscopic treatment of the hematoma was attempted. Puncture and incision were performed with an electrical needle knife. Two days after the procedure, the patient was tolerating a soft diet without complaints of abdominal pain or vomiting. The hematoma resolved completely on the follow-up studies.
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Affiliation(s)
- Chang-Il Kwon
- Department of Internal Medicine, Bundang CHA Hospital, College of Medicine, Pochon CHA University, Seongnam, Korea
| | - Kwang Hyun Ko
- Department of Internal Medicine, Bundang CHA Hospital, College of Medicine, Pochon CHA University, Seongnam, Korea
| | - Hyo Young Kim
- Department of Internal Medicine, Bundang CHA Hospital, College of Medicine, Pochon CHA University, Seongnam, Korea
| | - Sung Pyo Hong
- Department of Internal Medicine, Bundang CHA Hospital, College of Medicine, Pochon CHA University, Seongnam, Korea
| | - Seong Gyu Hwang
- Department of Internal Medicine, Bundang CHA Hospital, College of Medicine, Pochon CHA University, Seongnam, Korea
| | - Pil Won Park
- Department of Internal Medicine, Bundang CHA Hospital, College of Medicine, Pochon CHA University, Seongnam, Korea
| | - Kyu Sung Rim
- Department of Internal Medicine, Bundang CHA Hospital, College of Medicine, Pochon CHA University, Seongnam, Korea
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13
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Kim MK, Kim BW, Jang JW, Choi JH, Jung HJ, Ji JS, Choi H, Lee BI, Chae HS, Choi KY, Chung IS. Long-distance esophagogastric submucosal dissection after minimal esophageal trauma of a gastric tube. Gastrointest Endosc 2008; 68:605-7. [PMID: 18539277 DOI: 10.1016/j.gie.2007.12.053] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2007] [Accepted: 12/30/2007] [Indexed: 02/08/2023]
Affiliation(s)
- Min-Kuk Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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14
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Wu HC, Hsia JY, Hsu CP. Esophageal laceration with intramural dissection mimics esophageal perforation. Interact Cardiovasc Thorac Surg 2008; 7:864-5. [PMID: 18641013 DOI: 10.1510/icvts.2008.181560] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Esophageal laceration with intramural dissection is a rare type of injury but without perforation. It is difficult to differentiate from esophageal perforation at presentation time. We report the case of a 46-year-old man who was admitted to our hospital complaining of progressive chest pain, dysphagia, and odynophagia after swallowing a fish bone three days prior to admission. Esophagoscopy revealed a deep longitudinal laceration with pus discharge in the esophagus. Computed tomography of the chest revealed low posterior mediastinal abscess formation. Surgery was performed under the impression of esophageal perforation. The definite diagnosis was esophageal laceration with intramural dissection.
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Affiliation(s)
- Hui-Chung Wu
- Department of Surgery, Division of Thoracic Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
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15
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El-Chami MF, Martin RP, Lerakis S. Esophageal dissection complicating transesophageal echocardiogram--the lesson to be learned: do not force the issue. J Am Soc Echocardiogr 2006; 19:579.e5-7. [PMID: 16644447 DOI: 10.1016/j.echo.2005.12.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2005] [Indexed: 12/17/2022]
Abstract
Transesophageal echocardiogram is a very safe procedure, however, it is not devoid of complications. We report a case of esophageal dissection complicating transesophageal echocardiogram in a 52-year-old man who was treated conservatively. Moreover, we review briefly the complications of transesophageal echocardiogram.
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16
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Domínguez-Jiménez JL, Iglesias-Flores EM, Pleguezuelo-Navarro M, González-Galilea A, Gómez-Camacho F, Reyes López A, Hervás-Molina A, García-Sánchez MV, de Dios-Vega JF. Perforación intramural espontánea del esófago. GASTROENTEROLOGIA Y HEPATOLOGIA 2006; 29:294-6. [PMID: 16733035 DOI: 10.1157/13087469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Spontaneous intramural dissection of the esophagus (SIDE) is an unusual clinical entity. It is a benign disease that, despite its alarming endoscopic appearance, usually responds well to conservative management and has an excellent prognosis. Nevertheless, some situations require emergency surgical treatment. These situations include esophageal perforation with mediastinitis, massive bleeding, and abscess, among others. Upper gastrointestinal endoscopy is a useful diagnostic test when radiological examinations (hydrosoluble contrast esophagogram, computed tomography, or magnetic resonance imaging) have excluded perforation. We present the case of a 42-year-old woman who was admitted to our hospital complaining of acute chest pain, dysphagia, and odynophagia. Because of the persistence of symptoms and diagnostic uncertainty (SIDE versus complicated esophageal duplication cyst) surgery was performed. The definitive diagnosis was SIDE.
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Affiliation(s)
- J L Domínguez-Jiménez
- Unidad Clínica de Aparato Digestivo, Hospital Universitario Reina Sofía, Córdoba, España.
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17
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Kim SH, Lee SO. Circumferential intramural esophageal dissection successfully treated by endoscopic procedure and metal stent insertion. J Gastroenterol 2005; 40:1065-9. [PMID: 16322952 DOI: 10.1007/s00535-005-1692-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2005] [Accepted: 07/20/2005] [Indexed: 02/08/2023]
Abstract
Spontaneous intramural esophageal dissection is a rare disorder characterized by a lengthy laceration between the mucosal and submucosal layers of the esophageal wall, without perforation. The majority of previously reported cases of spontaneous intramural esophageal dissection were partial, and the circumferential type of intramural esophageal dissection has not been reported previously. Most spontaneous intramural esophageal dissection responds to conservative management, and usually it dose not lapse into a long protracted course of dealing with sequelae. We report an unusual case of circumferential intramural esophageal dissection, in which initial conservative management failed to alleviate the patient's dysphagia, necessitating the use of several endoscopic treatments, including incision of the septum between the false and true lumens, transection of the true esophageal wall, balloon dilatation, and metal stent insertion.
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Affiliation(s)
- Seong Hun Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chonbuk National University Medical School, 634-18, Jeonju, Chonbuk 561-712, Korea
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18
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Affiliation(s)
- Hsu-Heng Yen
- Department of Gastroenterology, ChangHua Christian Medical Center, ChangHua, 500 Taiwan, ROC
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19
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Chiu PWY, Cheung FKY, Ng NC, Ng EKW. Endoscopic mucosal incision with an insulated-tip knife for intramucosal esophageal dissection: case report. Gastrointest Endosc 2005; 62:184-7. [PMID: 15990850 DOI: 10.1016/s0016-5107(05)00129-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Philip W Y Chiu
- Upper Gastrointestinal Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
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