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Gao F, Zhang T, Guo X, Su Z. Embolization of the esophageal branch of intercostal artery for treatment of spontaneous intramural hematoma of the esophagus: a case description. Quant Imaging Med Surg 2023; 13:7417-7422. [PMID: 37869337 PMCID: PMC10585536 DOI: 10.21037/qims-23-564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 08/22/2023] [Indexed: 10/24/2023]
Affiliation(s)
- Fulei Gao
- Department of Interventional Radiology, Jiangyin Hospital Affiliated to Nantong University, Jiangyin, China
| | | | - Xinchun Guo
- Department of Interventional Radiology, Jiangyin Hospital Affiliated to Nantong University, Jiangyin, China
| | - Zhe Su
- Department of Gastroenterology, Jiangyin Hospital Affiliated to Nantong University, Jiangyin, China
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2
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Kim JH, Kim SH. Esophageal Laceration With Uncertain Cause. Gastroenterology 2023; 165:e7-e9. [PMID: 36804604 DOI: 10.1053/j.gastro.2023.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 02/05/2023] [Accepted: 02/14/2023] [Indexed: 02/23/2023]
Affiliation(s)
- Jun Hee Kim
- Division of Gastroenterology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Seung Han Kim
- Division of Gastroenterology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
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3
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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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4
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Tsakanov S. A close call: intramural oesophageal haematoma presenting with airway compromise. ANZ J Surg 2021; 92:1909-1910. [PMID: 34792278 DOI: 10.1111/ans.17374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 10/31/2021] [Accepted: 11/05/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Sergei Tsakanov
- Department of Surgery, Auburn Hospital, Sydney, New South Wales, Australia
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5
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Abdi S, Baianati MR, Momtahen M, Mohebbi B. Intramural Esophageal Dissection: A Rare Cause of Acute Chest Pain after Percutaneous Coronary Intervention. J Tehran Heart Cent 2019; 14:138-140. [PMID: 31998391 PMCID: PMC6981339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Intramural esophageal dissection is a condition that typically presents with chest pains and may be associated with hematemesis, odynophagia, and hematemesis. The role of antiplatelet/anticoagulant agents in the development of intramural esophageal hematoma is controversial. The management of intramural esophageal dissection is generally conservative with low mortality and morbidity. The case described here is a 66-year-old woman who presented with chest pains, odynophagia, and dysphagia 1 month after percutaneous coronary intervention while taking ASA (80 mg daily) and clopidogrel (75 mg daily) for dual antiplatelet therapy. The patient was diagnosed as intramural esophageal dissection and underwent successful conservative medical management. The relative contribution of dual antiplatelet therapy with ASA and clopidogrel after percutaneous coronary intervention in this case is, albeit uncertain, a possibility.
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Affiliation(s)
- Seifollah Abdi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | | | - Mahmood Momtahen
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | - Bahram Mohebbi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.,Corresponding Author: Bahram Mohebbi , Associate Professor of Cardiology, Interventional Cardiologist, Cardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical and Research Center, Vali-e-Asr Ave., Adjacent to Mellat Park, Niyayesh Blvd., Tehran, Iran. 1996911156. Tel: +98 21 2392580. Fax: +98 21 22055594. E-mail: .
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6
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Acute intramucosal dissection in eosinophilic esophagitis. Clin J Gastroenterol 2019; 12:525-529. [PMID: 31054020 DOI: 10.1007/s12328-019-00990-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 04/25/2019] [Indexed: 02/08/2023]
Abstract
Acute intramucosal dissection of the esophagus (IED) is a rare complication of eosinophilic esophagitis (EoE). Only few of such IED cases have been described in the literature. We report the case of a 32-year-old man with a 4-months diagnosis of EoE who was referred to the Emergency Department complaining of dysphagia, epigastric pain and fever and who was diagnosed, after an urgent endoscopy, an IED. After careful evaluation and multidisciplinary assessment the patient was managed conservatively, with specific medical therapy-high-dose proton pump inhibitors, swallowed steroid, broad-spectrum antibiotic-and, after a period of absolute fasting, a diet regimen based on "six food elimination diet" with a stepwise increase of food consistency. The patient experienced a rapid and complete relief of symptoms, paralleled by a progressive healing of IED with no recurrence over a 6-month follow-up period. In EoE patients with a high clinical suspicion of an acute IED, we suggest an early execution of chest CT and a contrast esophagography, avoiding potentially dangerous endoscopic procedures in the acute phase that can contribute to enlargement of the dissection, or progression to perforation. Once the diagnosis of IED is confirmed, even in the presence of a contained perforation, a conservative treatment with a multidisciplinary management should always be considered.
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7
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Wang C, Tseng P, Lee Y, Wu M, Wang H, Chen C. Spontaneous intramural esophageal dissection preceded by intramural esophageal hematoma: Report of a case study. ADVANCES IN DIGESTIVE MEDICINE 2019. [DOI: 10.1002/aid2.13106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Chih‐Hsien Wang
- Department of Internal MedicineNational Taiwan University Hospital Taipei Taiwan
- Department of Internal MedicineTaipei Hospital, Ministry of Health and Welfare New Taipei Taiwan
| | - Ping‐Huei Tseng
- Department of Internal MedicineNational Taiwan University Hospital Taipei Taiwan
| | - Yi‐Chia Lee
- Department of Internal MedicineNational Taiwan University Hospital Taipei Taiwan
| | - Ming‐Shiang Wu
- Department of Internal MedicineNational Taiwan University Hospital Taipei Taiwan
| | - Hsiu‐Po Wang
- Department of Internal MedicineNational Taiwan University Hospital Taipei Taiwan
| | - Chien‐Chuan Chen
- Department of Internal MedicineNational Taiwan University Hospital Taipei Taiwan
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8
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Yeom SK, Lee CH, Cha SH. "Double barreled esophagus" sign in the intramural dissection of esophagus. Abdom Radiol (NY) 2017; 42:983-984. [PMID: 27744550 DOI: 10.1007/s00261-016-0949-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Suk Keu Yeom
- Department of Radiology, Ansan Hospital, Korea University Medical Center, 123, Jeokgeum-ro, Danwon-gu, Ansan, Gyeonggi-do, 425-707, Korea
| | - Chang Hee Lee
- Department of Radiology, Korea University College of Medicine, Korea University Guro Hospital, 148, Gurodong-ro, Guro-Gu, Seoul, 08308, Korea.
| | - Sang Hoon Cha
- Department of Radiology, Ansan Hospital, Korea University Medical Center, 123, Jeokgeum-ro, Danwon-gu, Ansan, Gyeonggi-do, 425-707, Korea
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9
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Zhu RY, Law TT, Tong D, Tam G, Law S. Spontaneous circumferential intramural esophageal dissection complicated with esophageal perforation and esophageal-pleural fistula: a case report and literature review. Dis Esophagus 2016; 29:872-879. [PMID: 24602017 DOI: 10.1111/dote.12200] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Spontaneous intramural esophageal dissection (IED) is a rare disease entity. There are few reports of spontaneous IED requiring surgical treatment. Hereby, we report a 37-year-old gentleman who was diagnosed to have spontaneous extensive circumferential IED complicated with esophageal perforation, empyema, and esophageal-pleural fistula. Esophageal stenting and drainage of empyema were unsuccessful. Computed tomography and gastrografin contrast swallow demonstrated a leak to the pleural cavity, suggestive of esophageal-pleural fistula. Subsequently, a two-stage operation was performed: cervical esophagogastrostomy to bypass the perforated esophagus, followed by esophagectomy and decortication of the right lung. The patient recovered and was discharged home after a 3-week hospitalization. The management principles and recent published literature related to IED were reviewed.
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Affiliation(s)
- R Y Zhu
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - T T Law
- Division of Esophageal and Upper Gastrointestinal Surgery, Department of Surgery, University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - D Tong
- Division of Esophageal and Upper Gastrointestinal Surgery, Department of Surgery, University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - G Tam
- Division of Esophageal and Upper Gastrointestinal Surgery, Department of Surgery, University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - S Law
- Division of Esophageal and Upper Gastrointestinal Surgery, Department of Surgery, University of Hong Kong, Queen Mary Hospital, Hong Kong.
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10
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Mizumoto R, Van Rooyen H. Intramural oesophageal dissection as an unusual presentation of chest pain: A case report. Ann Med Surg (Lond) 2015; 4:376-9. [PMID: 26904189 PMCID: PMC4720711 DOI: 10.1016/j.amsu.2015.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 09/19/2015] [Accepted: 10/01/2015] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Intramural oesophageal dissection (IOD) is a rare clinical condition and there is a paucity of information regarding the appropriate diagnosis and management. It is described as bleeding in the submucosal plane of the oesophagus, and has various documented causes. PRESENTATION OF CASE We report a case of a 73 year old female who developed IOD. She presented with severe chest pain. Subsequent imaging revealed IOD and haematoma formation. This was confirmed on oesophagogastroduodenoscopy (OGD). She was on a bisphosphonate for her osteoporosis, as well as having age-related dysmotility of her oesophagus on manometric studies. She was also taking fish oil. Treatment was conservative and the patient was discharged with proton pump inhibitors and follow up. DISCUSSION Spontaneous haematoma formation and IOD resulted likely from a combination of the anticoagulant effect of fish oil and oesophageal dysmotility. Bisphosphonates also have some well documented gastrointestinal side effects involving mucosal damage. The possibility that the concurrent use of bisphosphonate led to a pre-existing ulcer which could have contributed to the development of IOD in this patient should be considered. CONCLUSION spontaneous IOD can occur in elderly patients who are anticoagulated. Fish oil has not been previously reported as having an association with IOD. This is the first known reported case of spontaneous IOD occurring in association with concurrent use of a bisphosphonate and fish oil. IOD is a rare disorder, and any anticoagulated patients presenting with severe chest pain may need careful investigation prior to definitive management.
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Affiliation(s)
- Ryo Mizumoto
- Department of Surgery, Hervey Bay Hospital, Urraween Road & Nissen Street, Pialba QLD 4655, Australia
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11
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Khil EK, Lee H, Her K. Spontaneous intramural full-length dissection of esophagus treated with surgical intervention: multidetector CT diagnosis with multiplanar reformations and virtual endoscopic display. Korean J Radiol 2014; 15:173-7. [PMID: 24497810 PMCID: PMC3909853 DOI: 10.3348/kjr.2014.15.1.173] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 10/21/2013] [Indexed: 12/02/2022] Open
Abstract
Intramural esophageal dissection (IED) is an uncommon disorder characterized by separation of the mucosal and submucosal layers of the esophagus. Iatrogenic intervention is the most common cause of IED, but spontaneous dissection is rare. We report an unusually complicated case of spontaneous IED that involved the full-length of the esophagus that necessitated surgical intervention due to infection of the false lumen. In this case, chest computed tomography successfully established the diagnosis and aided in pre-operative evaluation with the use of various image post-processing techniques.
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Affiliation(s)
- Eun Kyung Khil
- Department of Radiology, Soonchunhyang University Hospital Bucheon, Bucheon 420-767, Korea
| | - Heon Lee
- Department of Radiology, Soonchunhyang University Hospital Bucheon, Bucheon 420-767, Korea
| | - Keun Her
- Department of Thoracic and Cardiovascular Surgery, Soonchunhyang University Hospital Bucheon, Bucheon 420-767, Korea
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12
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A rare cause for acute chest pain in the emergency setting that is hard to swallow. Case Rep Emerg Med 2013; 2013:646342. [PMID: 23956888 PMCID: PMC3730207 DOI: 10.1155/2013/646342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Accepted: 07/01/2013] [Indexed: 12/05/2022] Open
Abstract
Intramural esophageal hematoma is a very rare but important cause of chest pain. This condition shares similarity with the diagnosis of other thoracic emergencies and has a high potential for misdiagnosis. The emergency clinician plays a critical role in the early identification and management of these patients. The management of intramural hematomas is typically conservative, and a misdiagnosis could lead to deleterious effects. Preexisting coagulopathy is one of the major risk factors. With the advent of new anticoagulation medications to prevent thromboembolic events, it is important that emergency medicine providers expand the differential diagnosis of chest pain.
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13
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Concannon ES, Khan F, O'Hanrahan T. Spontaneous intramural oesophageal haematoma: an unusual cause of chest pain. BMJ Case Rep 2011; 2011:bcr.09.2011.4837. [PMID: 22674601 DOI: 10.1136/bcr.09.2011.4837] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The following case describes a 29-year-old previously well gentleman who presented with an acute onset of chest pain, dysphagia, odynophagia and vomiting without haematemesis. An oesophageal lesion was visualised on CT angiography and further investigation via oesophogastroduodenoscopy (OGD) diagnosed a spontaneous intramural oesophageal haematoma as the cause of his symptomatology. Conservative medical management in the form of triple therapy and softened diet was well tolerated and a follow-up OGD at 6 weeks after discharge from hospital showed spontaneous resolution of the haematoma.
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14
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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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15
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Affiliation(s)
- Shiao-Yen Khoo
- Resident in Internal Medicine, Mayo School of Graduate Medical Education, Mayo Clinic, Rochester, MN
| | - George W. Deimel
- Resident in Internal Medicine, Mayo School of Graduate Medical Education, Mayo Clinic, Rochester, MN
| | - John G. Park
- Adviser to residents and Consultant in Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
- Individual reprints of this article are not available. Address correspondence to John G. Park, MD, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905 ()
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16
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Chu YY, Sung KF, Ng SC, Cheng HT, Chiu CT. Achalasia combined with esophageal intramural hematoma: Case report and literature review. World J Gastroenterol 2010; 16:5391-4. [PMID: 21072906 PMCID: PMC2980692 DOI: 10.3748/wjg.v16.i42.5391] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
A 62-year-old male patient was admitted to our hospital due to severe chest pain, odynophagia, and hematemesis. Chest computed tomography showed an esophageal submucosal tumor. Esophagogastroduodenoscopy (EGD) revealed a longitudinal purplish bulging tumor of the esophagus. Endoscopic ultrasound (EUS) showed a mixed echoic tumor with partial liquefaction from the submucosal layer. The patient was diagnosed with esophageal intramural hematoma as well as achalasia by upper gastrointestinal endoscopy, esophagography and esophageal manometry. The patient was managed conservatively with intravenous nutrition, and oral feeding was discontinued. Follow-up EGD and EUS showed complete recovery of the esophageal wall, and finally, the patient underwent endoscopic dilatation for achalasia. The patient was symptom free at the time when we wrote this manuscript.
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17
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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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18
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Combined esophageal injury complicated by progression to a second perforation: a case report. J Med Case Rep 2009; 3:9213. [PMID: 19918291 PMCID: PMC2767153 DOI: 10.4076/1752-1947-3-9213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2008] [Accepted: 04/06/2009] [Indexed: 02/08/2023] Open
Abstract
Introduction Intramural dissection of the esophagus is a rare disorder characterized by a lesion between the submucosa and mucosa dividing the esophagus into a false and true lumen. The etiology of esophageal dissection remains uncertain but it affects predominantly women in their seventies and eighties. Symptoms may include uncharacteristic ones such as retrosternal pain, odynophagia or dysphagia. Conservative management is thought to be adequate and surgery should only be performed if complications such as abscess formation or perforation appear. Here we report the case and surgical management of a combined esophageal perforation and dissection. Case presentation We report the case of a combined esophageal perforation and dissection in a 45-year-old Caucasian woman with a history of relapsing periods of dysphagia since her childhood. The clinical course in this patient was complicated by progression to a second perforation, which made a definitive surgical management by esophagectomy necessary. Conclusion To the best of our knowledge, this is the first reported case of a combined esophageal perforation and dissection complicated by progression to a second perforation. This emphasizes that cautious and intensive observation is necessary in patients with esophageal dissection.
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Tang SJ, Tang L, Jazrawi SF, Meyer D, Wait MA, Myers LL. Iatrogenic esophageal submucosal dissection after attempted diagnostic gastroscopy (with videos). Laryngoscope 2009; 119:36-8. [PMID: 19117296 DOI: 10.1002/lary.20006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Diagnostic esophagogastroduodenoscopy (EGD) is generally a very safe procedure. We report the first case of iatrogenic esophageal submucosal dissection after an attempted diagnostic gastroscopy in a patient with a small previously undiagnosed Zenker's diverticulum (ZD). After EGD, she developed severe dysphagia with the inability to swallow solids, liquids, and even her own saliva. On barium swallow study, there was a column of contrast below the upper esophageal sphincter, and this was misdiagnosed as a large ZD by the radiologist. The resultant stricture was successfully managed with endoscopic balloon dilatation under fluoroscopy with wire-guided cannulation. The ZD was treated with flexible endoscopic clip-assisted diverticulotomy. Iatrogenic submucosal dissection is a unique complication of upper endoscopy. Endoscopists, otolaryngologists, radiologists, and cardiothoracic surgeons should be aware of this condition and prepare to manage it appropriately. If the patient is stable and the possibility of perforation is small, conservative and supportive care can be tried first. A surgical gastrostomy tube can be placed for enteral feeding. In patients with ZD, ZD recognition and gentle manipulation is strongly recommended during esophageal intubation.
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Affiliation(s)
- Shou-jiang Tang
- Division of Digestive and Liver Diseases, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas 75390-9151, USA.
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20
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von Renteln D, Walz B, Riecken B, Kayser T, Caca K. Endoscopic management of acute esophageal dissection by using a covered, self-expanding metal stent (with video). Gastrointest Endosc 2009; 69:577-80. [PMID: 18692845 DOI: 10.1016/j.gie.2008.04.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2008] [Accepted: 04/22/2008] [Indexed: 02/08/2023]
Affiliation(s)
- Daniel von Renteln
- Department of Gastroenterology, Hepatology and Oncology, Klinikum Ludwigsburg, Ludwigsburg, Germany
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21
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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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22
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Soulellis CA, Hilzenrat N, Levental M. Intramucosal esophageal dissection leading to esophageal perforation: case report and review of the literature. Gastroenterol Hepatol (N Y) 2008; 4:362-365. [PMID: 21904510 PMCID: PMC3093724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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23
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Heitmiller RF. Intramural esophageal dissection with perforation. Gastroenterol Hepatol (N Y) 2008; 4:365-366. [PMID: 21904511 PMCID: PMC3093725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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24
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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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25
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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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26
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Affiliation(s)
- Hsu-Heng Yen
- Department of Gastroenterology, ChangHua Christian Medical Center, ChangHua, 500 Taiwan, ROC
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27
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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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28
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Abstract
SUMMARY. We present a case of a 20-year-old, previously healthy, male student who presented with dysphagia secondary to mechanical esophageal obstruction that resolved spontaneously. Although our patient did not have 'classic' patient characteristics, we believe that the clinical evidence supports the conclusion that our patient was an atypical presentation of intramural esophageal hematoma.
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Affiliation(s)
- S C Lauzon
- Department of Surgery, Union Memorial Hospital, Baltimore, Maryland 21218, USA
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29
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van Beljon J, Krige JEJ, Bornman PC. Intramural esophageal hematoma after endoscopic injection sclerotherapy for bleeding varices. Dig Endosc 2004. [DOI: 10.1111/j.1443-1661.2004.00299.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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30
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K C S, Kouzu T, Matsutani S, Hishikawa E, Saisho H. Early endoscopic treatment of intramural hematoma of the esophagus. Gastrointest Endosc 2003; 58:297-301. [PMID: 12872110 DOI: 10.1067/mge.2003.356] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Sudhamshu K C
- Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
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31
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Cho CM, Ha SS, Tak WY, Kweon YO, Kim SK, Choi YH, Chung JM. Endoscopic incision of a septum in a case of spontaneous intramural dissection of the esophagus. J Clin Gastroenterol 2002; 35:387-90. [PMID: 12394226 DOI: 10.1097/00004836-200211000-00006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Intramural dissection of the esophagus is a rare esophageal disorder that is characterized by a long laceration between the esophageal mucosa and submucosa but without perforation. It reveals characteristic radiologic and endoscopic features. The etiology of intramural dissection of the esophagus remains uncertain. The most common presenting symptoms are sudden retrosternal pain, hematemesis, odynophagia, dysphagia, and back pain. Conservative management is usually thought to be adequate. We report a case of spontaneous intramural esophageal dissection, in which the symptom of dysphagia did not improve with the conservative management, and an endoscopic incision of the septum between true and false lumens using a needle-type diathermy knife was done safely and effectively.
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Affiliation(s)
- Chang-Min Cho
- Department ofInternal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea.
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32
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Gluck M, Jiranek GC, Low DE, Kozarek RA. Spontaneous intramural rupture of the esophagus: clinical presentation and endoscopic findings. Gastrointest Endosc 2002; 56:134-6. [PMID: 12085053 DOI: 10.1067/mge.2002.125360] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Michael Gluck
- Gastroenterology, Virginia Mason Medical Center, Seattle, Washington 98111, USA
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33
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Jung KW, Lee OJ. Extensive spontaneous submucosal dissection of the esophagus: long-term sequential endoscopic observation and treatment. Gastrointest Endosc 2002; 55:262-5. [PMID: 11818937 DOI: 10.1067/mge.2002.121872] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Kee-Wook Jung
- Department of Internal Medicine and Gyeongsang Institute of Cancer Research, Gyeongsang National University College of Medicine, Chinju, Kyongnam, Republic of Korea
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34
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35
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36
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Abstract
Spontaneous intramural hematoma of the esophagus (SIHE) is a rare condition, usually presenting with severe acute chest pain. Vomiting, dysphagia, odynophagia, and hematemesis may appear later. We herein report a case of this disease in a patient treated with low doses of aspirin, and review the literature for possible etiologies for this condition. In addition, we compare the utility of the various diagnostic modalities in this uncommon condition.
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Affiliation(s)
- N Hiller
- Department of Radiology, Shaare Zedek Medical Center, Jerusalem, Israel
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37
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MURAKAMI M, HOSHIKA A, YANO H, ARAKI K, YANO T, OHSHIMA K, KOKUBU S. Hematoma with High Oxygen Partial Pressure Resulting from Injection Sclerotherapy for Esophageal Varices — Report of a Case. Dig Endosc 1999. [DOI: 10.1111/j.1443-1661.1999.tb00193.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
| | - Akiko HOSHIKA
- *Department of Gastroenterology, Matsuyama Shimin Hospital, Matsuyama, Ehime, Japan
| | - Harumi YANO
- *Department of Gastroenterology, Matsuyama Shimin Hospital, Matsuyama, Ehime, Japan
| | - Katsuyuki ARAKI
- *Department of Gastroenterology, Matsuyama Shimin Hospital, Matsuyama, Ehime, Japan
| | - Tetsuro YANO
- *Department of Gastroenterology, Matsuyama Shimin Hospital, Matsuyama, Ehime, Japan
| | - Kanji OHSHIMA
- *Department of Gastroenterology, Matsuyama Shimin Hospital, Matsuyama, Ehime, Japan
| | - Shigehiro KOKUBU
- **Department of Gastroenterology, Kitasato University East Hospital, Sagamihara, Kanagawa, Japan
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38
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Abstract
A case of intramural esophageal dissection is reported and the literature reviewed. Patients with intramural esophageal dissection are usually women in their seventh or eighth decade. The most common presenting symptoms are chest pain, dysphagia, and hematemesis. The diagnosis is made by contrast esophagography, esophagoscopy, or both. Nonoperative therapy has proved to be uniformly successful.
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Affiliation(s)
- G Q Phan
- Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
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39
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Sen A, Lea RE. Spontaneous oesophageal haematoma: a review of the difficult diagnosis. Ann R Coll Surg Engl 1993; 75:293-5. [PMID: 8379637 PMCID: PMC2497955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Three cases of spontaneous oesophageal haematoma are described, with particular emphasis on their confusing clinical presentation. CT scanning was found to be helpful in making a correct diagnosis. This led to conservative treatment and ultimate full recovery.
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Affiliation(s)
- A Sen
- Wessex Cardiothoracic Unit, Southampton General Hospital
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40
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Furukawa H, Hara T, Taniguchi T, Tetsu O. A case of spontaneous intramural hematoma of the esophagus. GASTROENTEROLOGIA JAPONICA 1993; 28:81-7. [PMID: 8440426 DOI: 10.1007/bf02775007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The authors experienced a case of spontaneous intramural hematoma of the esophagus (SIHE). This 44-year-old Japanese woman was admitted to our hospital because of chest pain accompanied by minimal hematemesis. Endoscopy revealed an elevated intraluminal bleeding bulge. Barium esophagograms showed a smooth and giant elevated intraluminal lesion. CT and MRI also revealed thickening of the esophageal wall. Fasting and intravenous hyperalimentation were prescribed on admission. The conditions improved and she became asymptomatic on the fifth day of hospitalization. Subsequent examinations by esophagography and endoscopy showed that the elevated lesion had disappeared and that the inflamed mucosal lesion had improved. The prognosis of cases of SIHE is excellent under conservative therapy, but close follow-up care is necessary.
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Affiliation(s)
- H Furukawa
- Department of Surgery, Shimizu Kosei Hospital, Japan
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41
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Folan RD, Smith RE, Head JM. Esophageal hematoma and tear requiring emergency surgical intervention. A case report and literature review. Dig Dis Sci 1992; 37:1918-21. [PMID: 1473441 DOI: 10.1007/bf01308089] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Esophageal hematoma is a disorder characterized by the sudden development of pain, hematemesis, or dysphagia, commonly with minimal precipitant. We present the case of 59-year-old man with esophageal hematoma, precipitated by eating, with massive hematemesis requiring surgical intervention. A review of 31 additional cases in the literature since 1980 is discussed. The Mallory-Weiss syndrome and Boerhaave syndrome are distinct entities with some clinical similarities.
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Affiliation(s)
- R D Folan
- Division of Gastroenterology, Veterans Administration Hospital, White River Junction, Vermont
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42
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de Vries RA, Kremer-Schneider MM, Otten MH. Intramural hematoma of the esophagus caused by minor head injury 6 hours previously. GASTROINTESTINAL RADIOLOGY 1991; 16:283-5. [PMID: 1936765 DOI: 10.1007/bf01887368] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The diagnosis of extensive intramural hematoma of the esophagus due to a bicycle trauma was considerably delayed because symptoms did not develop until 6 h after the accident. This report underscores the importance of a barium meal and computed tomographic (CT) scan in cases of unexplained chest pain, even after minor trauma.
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Affiliation(s)
- R A de Vries
- Department of Medicine, Lichtenberg Hospital, Amersfoort, The Netherlands
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43
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Abstract
Esophageal injuries are potentially serious disorders requiring prompt recognition and management. In addition to the well-recognized Mallory-Weiss and Boerhaave's syndromes, there exists a condition of spontaneous intramural esophageal hemorrhage: esophageal apoplexy. A case of esophageal apoplexy is presented as well as an evaluation of clinical presentations based on a collected review of the 66 cases previously reported. In addition, esophageal apoplexy is contrasted with the Mallory-Weiss and Boerhaave's syndromes, focusing on distinguishing attributes of utility to the emergency practitioner.
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Affiliation(s)
- R S Jotte
- George Washington/Georgetown University, Emergency Medicine Residency, Washington, D.C. 20037
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44
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Affiliation(s)
- J M Hanson
- Department of Surgery, Hope Hospital, Salford
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45
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Steadman C, Kerlin P, Crimmins F, Bell J, Robinson D, Dorrington L, McIntyre A. Spontaneous intramural rupture of the oesophagus. Gut 1990; 31:845-9. [PMID: 2387502 PMCID: PMC1378606 DOI: 10.1136/gut.31.8.845] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The clinical, endoscopic, and radiological features of seven patients with an uncommon oesophageal injury characterised by long lacerations of the oesophageal mucosa with haematoma formation but without perforation are reported. The injuries were not related to forceful vomiting or any other definable cause but were similar to those previously described as intramural oesophageal rupture. Upper gastrointestinal endoscopy undertaken to identify the cause of haematemesis in six patients proved safe and useful. When dysphagia and odynophagia occurred early in the clinical course to alert the clinician to possible oesophageal injury, radiological contrast studies were used to exclude perforation. One patient in this study had oesophageal cavernocapillary haemangiomatosis which may have caused intramural oesophageal bleeding and submucosal dissection but in the remainder the aetiology of intramural oesophageal rupture remains uncertain. Conservative management was successful in all patients.
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Affiliation(s)
- C Steadman
- Department of Gastroenterology, Princess Alexandra Hospital, Queensland, Australia
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46
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Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 44-1989. A 74-year-old woman with subxiphoid pain and narrowing of the esophagus. N Engl J Med 1989; 321:1249-59. [PMID: 2797088 DOI: 10.1056/nejm198911023211807] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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47
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Abstract
Six cases of spontaneous submucosal dissection of the oesophagus are described. This rare entity should be considered in patients presenting with chest pain, usually of sudden onset, associated with dysphagia and haematemesis. Barium swallow or endoscopy are needed to confirm the diagnosis and the characteristic features are described.
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Affiliation(s)
- A H Freeman
- Department of Radiology, Addenbrooke's Hospital, Cambridge
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48
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Yeoh NT, McNicholas T, Rothwell-Jackson RL, Goldstraw P. Intramural rupture and intramural haematoma of the oesophagus. Br J Surg 1985; 72:958-60. [PMID: 4084753 DOI: 10.1002/bjs.1800721208] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
We report on two cases of spontaneous intramural rupture and haematoma formation in the oesophagus. This is an unusual and often misdiagnosed condition. Its diagnosis relies on the history and a barium swallow. Instrumentation can result in further damage to the oesophagus and should be avoided. Treatment is conservative and results in resolution of the haematoma and a return to normal swallowing.
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49
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Van Steenbergen W, Fevery J, Broeckaert L, Ponette E, Baert A, De Groote J. Intramural hematoma of the esophagus: unusual complication of variceal sclerotherapy. GASTROINTESTINAL RADIOLOGY 1984; 9:293-5. [PMID: 6334005 DOI: 10.1007/bf01887854] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
A patient is described who developed severe retrosternal pain and dysphagia immediately after sclerotherapy of esophageal varices. Extensive submucosal bleeding of the esophageal wall was demonstrated radiologically and endoscopically. This lesion resolved within 2 weeks of conservative treatment.
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50
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Natsuda Y, Kuwano H, Ezaki T, Sugimachi K, Inokuchi K. Spontaneous submucosal dissection of the esophagus. A case report. THE JAPANESE JOURNAL OF SURGERY 1983; 13:354-7. [PMID: 6645125 DOI: 10.1007/bf02469519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
A forty year-old Japanese woman complained of slight hematemesis and severe pain on swallowing. Fluoroscopic examination showed typical esophagograms of "double barreled esophagus" or "mucosal stripe". An esophageal ulceration, probably where the dissection re-entered the usual lumen, was endoscopically evident at the lower end of the mucosal bulging. A large, shallow ulcer of unknown cause was also identified in the just anal area from the esophago-gastric junction. She recovered with conservative treatment of fasting, cimetidine and sodium alginate.
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