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Oba J, Usuda D, Tsuge S, Sakurai R, Kawai K, Matsubara S, Tanaka R, Suzuki M, Takano H, Shimozawa S, Hotchi Y, Usami K, Tokunaga S, Osugi I, Katou R, Ito S, Mishima K, Kondo A, Mizuno K, Takami H, Komatsu T, Nomura T, Sugita M. Hemorrhagic shock due to submucosal esophageal hematoma along with mallory-weiss syndrome: A case report. World J Clin Cases 2022; 10:9911-9920. [PMID: 36186194 PMCID: PMC9516938 DOI: 10.12998/wjcc.v10.i27.9911] [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: 05/19/2022] [Revised: 08/08/2022] [Accepted: 08/17/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Esophageal submucosal hematoma is a rare condition. Although the exact etiology remains uncertain, vessel fragility with external factors is believed to have led to submucosal bleeding and hematoma formation; the vessel was ruptured by a sudden increase in pressure due to nausea, and the hematoma was enlarged by antiplatelet or anticoagulant therapy. Serious conditions are rare, with a better prognosis. We present the first known case of submucosal esophageal hematoma-subsequent hemorrhagic shock due to Mallory-Weiss syndrome.
CASE SUMMARY A 73-year-old female underwent endovascular treatment for an unruptured cerebral aneurysm. The patient received aspirin and clopidogrel before surgery and heparin during surgery, and was well during the surgery. Several hours after returning to the ICU, she complained of chest discomfort, vomited 500 mL of fresh blood, and entered hemorrhagic shock. Esophageal submucosal hematoma with Mallory-Weiss syndrome was diagnosed through an endoscopic examination and computed tomography. In addition to a massive fluid and erythrocyte transfusion, we performed a temporary compression for hemostasis with a Sengstaken-Blakemore (S-B) tube. Afterwards, she became hemodynamically stable. On postoperative day 1, we performed an upper gastrointestinal endoscopy and confirmed no expansion of the hematoma nor any recurring bleeding; therefore, we removed the S-B tube and clipped the gastric mucosal laceration at the esophagogastric junction. We started oral intake on postoperative day 10. The patient made steady progress, and was discharged on postoperative day 33.
CONCLUSION We present the first known case of submucosal esophageal hematoma subsequent hemorrhagic shock due to Mallory-Weiss syndrome.
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Affiliation(s)
- Jiro Oba
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Daisuke Usuda
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Shiho Tsuge
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Riki Sakurai
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Kenji Kawai
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Shun Matsubara
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Risa Tanaka
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Makoto Suzuki
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Hayabusa Takano
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Shintaro Shimozawa
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Yuta Hotchi
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Kenki Usami
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Shungo Tokunaga
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Ippei Osugi
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Risa Katou
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Sakurako Ito
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Kentaro Mishima
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Akihiko Kondo
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Keiko Mizuno
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Hiroki Takami
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Takayuki Komatsu
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
- Faculty of Medicine, Juntendo University, Bunkyo-ku 113-8421, Tokyo, Japan
| | - Tomohisa Nomura
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Manabu Sugita
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
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2
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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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3
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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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4
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Oe S, Watanabe T, Kume K, Shibata M, Hiura M, Yoshikawa I, Harada M. A case of idiopathic gastroesophageal submucosal hematoma and its disappearance observed by endoscopy. J UOEH 2014; 36:123-128. [PMID: 24930876 DOI: 10.7888/juoeh.36.123] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A 74-year-old man was hospitalized due to hematemesis. Upper gastrointestinal endoscopy revealed a very large and dark red mass in the cardiac region of the stomach that extended from the upper esophagus. A biopsy specimen showed hemorrhagic tissue and no malignant cells. The tumor-like region ulcerated at 5 days after the administration of intravenous lansoprazole at a dose of 30 mg twice a day and resolved with scar formation at 2 months after a change to oral rabeprazole at a dose of 10 mg/day.We diagnosed the patient with gastroesophageal submucosal hematoma. Gastroesophageal submucosal hematoma is a rare complication. In this case, we could follow the process of its disappearance by endoscopy.
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Affiliation(s)
- Shinji Oe
- Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan
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5
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Hajsadeghi S, Agah S, Iranpour A, Chehrehgosha H, Ghanooni AH, Forghani F. Dissecting intramural hematoma of esophagus after thrombolytic therapy: a case report. Asian Cardiovasc Thorac Ann 2014; 23:224-6. [PMID: 24585301 DOI: 10.1177/0218492314522637] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Esophageal hematoma is a relatively rare event. We report a case of severe chest pain associated with myocardial infarction and recurrent chest pain after administration of a thrombolytic agent. The chest pain was different from the presenting symptom and accompanied by 2 episodes of hematemesis. Esophageal hematoma was confirmed after endoscopy and computed tomography. Esophageal hematoma is a relatively rare event after thrombolytic therapy.
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Affiliation(s)
- Shokufeh Hajsadeghi
- Department of Cardiology, Iran University of Medical Sciences, Rasool Akram General Hospital, Tehran, Iran
| | - Shahram Agah
- Department of Gastroenterology, Colorectal Research Center, Iran University of Medical Sciences, Rasool Akram General Hospital, Tehran, Iran
| | - Aida Iranpour
- Department of Internal Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Haleh Chehrehgosha
- Department of Internal Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Hossein Ghanooni
- Department of Internal Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Foroogh Forghani
- Department of Gastroenterology, Iran University of Medical Sciences, Rasool Akram General Hospital, Tehran, Iran
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6
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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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7
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Pomara C, Bello S, D'Errico S, Greco M, Fineschi V. Sudden death due to a dissecting intramural hematoma of the esophagus (DIHE) in a woman with severe neurofibromatosis-related scoliosis. Forensic Sci Int 2013; 228:e71-5. [PMID: 23453641 DOI: 10.1016/j.forsciint.2013.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Revised: 09/03/2012] [Accepted: 02/04/2013] [Indexed: 12/28/2022]
Abstract
Dissecting intramural hematoma of the esophagus (DIHE) is a rare condition in which intramural hemorrhage can lead to submucosal dissection of the esophageal wall. DIHE is generally considered a benign disease, and the only mortality associated with DIHE has been due to operative intervention or to the presence of another underlying, life-threatening condition. We report, however, a case of sudden death due to the spontaneous rupture of a DIHE that occurred in a 32-year-old woman, affected by neurofibromatosis type 1. She was admitted to the local emergency room, presenting a 24-hour history of sudden onset, severe central chest and interscapular pain associated with dysphagia, odynophagia and vomiting. Her condition worsened and proved fatal within a 6-hour period. A complete autopsy was then conducted, showing a complete dissecting intramural hematoma with laceration of the third superior of the esophagus. We can hypothesize that abnormal variations of gastro-esophageal pressure during ingurgitation and during bolus movement could be predisposing factors in the pathogenesis of the dissection. On the other hand angular kyphoscoliosis deformity may have had play a role as precipitating factor while vomiting in the subject's medical history can then be interpreted as the likely activation phenomenon.
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Affiliation(s)
- Cristoforo Pomara
- Department of Forensic Pathology, University of Foggia, Ospedale Colonnello D'Avanzo, Via degli Aviatori 1, 71100 Foggia, Italy
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8
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Affiliation(s)
- Sang Pyo Lee
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
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9
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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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10
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Park HW, Kim SJ, Park JW, Shin WG, Kim KH, Jang MK, Lee JH, Kim HY, Kim HS. Pill-related esophageal intramural dissection treated by an endoscopic procedure. Gastrointest Endosc 2011; 74:1422-4. [PMID: 22136787 DOI: 10.1016/j.gie.2010.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Accepted: 12/08/2010] [Indexed: 02/08/2023]
Affiliation(s)
- Hye Won Park
- Department of Internal Medicine, Kangdong Sacred Heart Hospital of Hallym University Medical Center, Seoul, South Korea
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11
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Endoscopic Ultrasound Images of Esophageal Intramural Hematoma. J Med Ultrasound 2010. [DOI: 10.1016/j.jmu.2010.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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12
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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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13
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Shim J, Jang JY, Hwangbo Y, Dong SH, Oh JH, Kim HJ, Kim BH, Chang YW, Chang R. Recurrent massive bleeding due to dissecting intramural hematoma of the esophagus: Treatment with therapeutic angiography. World J Gastroenterol 2009; 15:5232-5. [PMID: 19891027 PMCID: PMC2773907 DOI: 10.3748/wjg.15.5232] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [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
Spontaneous or traumatic intramural bleeding of the esophagus, which is often associated with overlying mucosal dissection, constitutes a rare spectrum of esophageal injury called dissecting intramural hematoma of the esophagus (DIHE). Chest pain, swallowing difficulty, and minor hematemesis are common, which resolve spontaneously in most cases. This case report describes a patient with spontaneous DIHE with recurrent massive bleeding which required critical management and highlights a potential role for therapeutic angiography as an alternative to surgery.
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14
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Chiu YH, Chen JD, Hsu CY, How CK, Yen DHT, Huang CI. Spontaneous esophageal injury: esophageal intramural hematoma. J Chin Med Assoc 2009; 72:498-500. [PMID: 19762321 DOI: 10.1016/s1726-4901(09)70416-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Acute chest pain can indicate a life-threatening condition and it is important for physicians to diagnose and treat it as a matter of urgency. We report 1 rare case of esophageal intramural hematoma (IMH) that presented with chest pain at the emergency department and which was initially clinically suspected to be due to aortic dissection. The case was diagnosed preoperatively by multidetector computed tomography. Esophageal IMH may represent an intermediate stage between Mallory-Weiss tear (mucosal) and Boerhaave's syndrome (transmural). Multidetector computed tomography is a useful noninvasive imaging modality for accurate diagnosis of these spontaneous intramural and transmural ruptures of the esophagus, and aids in the differential diagnosis of aortic and other mediastinal diseases with acute chest pain.
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Affiliation(s)
- Yu-Hui Chiu
- Department of Emergency Medicine, Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan, ROC
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15
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[Massive hemoperitoneum due to rupture of an spontaneous intramural oesophageal haematoma]. Cir Esp 2009; 87:330-2. [PMID: 19589507 DOI: 10.1016/j.ciresp.2009.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2009] [Accepted: 03/31/2009] [Indexed: 11/22/2022]
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16
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Meyer MM, Levine EJ. Cricopharyngeal intramural hematoma: an unusual complication of orthopedic intervention. Dysphagia 2009; 24:438-40. [PMID: 19472006 DOI: 10.1007/s00455-009-9218-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2009] [Accepted: 03/03/2009] [Indexed: 11/25/2022]
Affiliation(s)
- Marty M Meyer
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Medical Center, Columbus, OH, 43210, USA.
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17
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Restrepo CS, Lemos DF, Ocazionez D, Moncada R, Gimenez CR. Intramural hematoma of the esophagus: a pictorial essay. Emerg Radiol 2007; 15:13-22. [PMID: 17952475 DOI: 10.1007/s10140-007-0675-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2007] [Accepted: 09/20/2007] [Indexed: 12/22/2022]
Abstract
Intramural hematoma of the esophagus (IHE) is a rare but well-documented condition that is part of the spectrum of esophageal injuries which includes the more common Mallory-Weiss tear and Boerhaave's syndrome. Acute retrosternal or epigastric pain is a common clinical feature, which can be accompanied by dysphagia, odynophagia, or hematemesis. An early differentiation from Mallory-Weiss tear, Boerhaave syndrome, ruptured aortic aneurysm, aortic dissection, acute myocardial infarction, or pulmonary pathology can be difficult. Computed tomography (CT) is the imaging modality of choice and characteristically reveals a concentric or eccentric thickening of the esophageal wall with well-defined borders and variable degree of obliteration of the lumen. Measurement of the attenuation values within the lesion will reveal blood density which varies according to the age of the hematoma. CT should be considered the preferred diagnostic technique, thereby facilitating proper clinical management. Early diagnosis is crucial as most patients may be treated conservatively with good outcome.
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Affiliation(s)
- Carlos S Restrepo
- Department of Radiology, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900, USA.
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18
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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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Abstract
Hematoma of the esophagus is an uncommon condition. Patients often present with acute odynophagia or retrosternal pain, which may be confused with other diagnoses. We report herein two patients with esophageal hematoma caused by foreign body ingestion. Conservative treatment resulted in complete resolution. The literature is reviewed for the etiology, clinical features and management of this condition.
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Affiliation(s)
- M Tong
- Division of Esophageal Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong
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20
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Abstract
We report the case of an 80-year-old woman who developed a spontaneous intramural esophageal hematoma and review the available literature. Spontaneous intramural esophageal hematoma (SIOH) is a rare but important condition. Because the cardinal symptom is severe chest pain, the condition is often initially misdiagnosed as an acute cardiac event or aortic dissection. Increased awareness of SIOH may prevent misdiagnosis on the basis of endoscopic and radiological appearances.
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Affiliation(s)
- Sarah C Thomasset
- Department of Surgery, Leicester General Hospital, Leicester, England.
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21
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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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22
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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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23
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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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25
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Younes Z, Johnson DA. The spectrum of spontaneous and iatrogenic esophageal injury: perforations, Mallory-Weiss tears, and hematomas. J Clin Gastroenterol 1999; 29:306-17. [PMID: 10599632 DOI: 10.1097/00004836-199912000-00003] [Citation(s) in RCA: 93] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Esophageal perforations, Mallory-Weiss tears, and esophageal hematoma involve traumatic injury to the esophagus. These can be iatrogenic, in particular due to esophageal instrumentation, but can also occur spontaneously. The remarkable increase in diagnostic and therapeutic endoscopy as well as esophageal surgery has made instrumentation the most common cause of esophageal perforation. In many instances, spontaneous perforations are associated with retching and vomiting, which causes a sudden increase in intraesophageal pressure. A high index of suspicion leading to rapid diagnosis and appropriate therapy are needed to optimize clinical outcomes. This article focuses on esophageal perforations, Mallory-Weiss tears, and esophageal hematomas, with emphasis on etiology, pathogenesis, clinical presentation, diagnosis, management, and prevention.
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Affiliation(s)
- Z Younes
- Department of Internal Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
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26
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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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27
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Affiliation(s)
- P A Kitchen
- Department of Gastroenterology, Northwick Park and St Marks Hospital NHS Trust, Harrow, Middlesex, UK
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28
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Geller A, Gostout CJ. Esophagogastric hematoma mimicking a malignant neoplasm: clinical manifestations, diagnosis, and treatment. Mayo Clin Proc 1998; 73:342-5. [PMID: 9559038 DOI: 10.1016/s0025-6196(11)63700-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Esophagogastric hematoma is a rare condition occurring spontaneously or after esophageal instrumentation. In this report, we describe a patient with acute dysphagia in whom a lower esophageal mass was detected radiographically. Upper endoscopy revealed an esophageal mass that extended from the mid-esophagus to the gastroesophageal junction and was associated with a malignant-appearing ulcerated mass (5 to 6 cm) in the cardia. Gastric cancer with esophageal extension was the presumptive diagnosis. Computed tomography showed that the esophageal mass had a density similar to blood, a finding suggesting the presence of an esophageal hematoma. Biopsy specimens of the ulcer revealed acute inflammation but no malignant involvement. The patient was treated conservatively, and the initial symptoms resolved. Esophagogastric hematomas can mimic a neoplasm; thus, establishing the correct diagnosis is important because this condition has a favorable prognosis, and only conservative treatment is needed.
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Affiliation(s)
- A Geller
- Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, Minnesota 55905, USA
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29
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Abstract
Two cases of acute submucosal esophageal hemorrhage are reported. This condition is uncommon and presents an urgent diagnostic dilemma. Its presentation, diagnosis, and management are reviewed. The underlying pathology and causative factors are researched and clarified. Conservative management is safe and effective.
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Affiliation(s)
- C E Nwogu
- Division of Cardiothoracic Surgery, University of Massachusetts Medical Center, Worcester 01655, USA
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30
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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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31
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DRACR; WC, Cook IJ. Spontaneous intramural haematoma of the oesophagus: Radiologic recognition. ACTA ACUST UNITED AC 1996. [DOI: 10.1111/j.1440-1673.1996.tb00401.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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32
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Kamphuis AG, Baur CH, Freling NJ. Intramural hematoma of the esophagus: appearance on magnetic resonance imaging. Magn Reson Imaging 1995; 13:1037-42. [PMID: 8583868 DOI: 10.1016/0730-725x(95)00047-k] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A 73-yr-old woman on anticoagulant therapy experienced progressive dyspnea and dysphagia due to a large compressing mass in the posterior mediastinum. Because her clinical condition deteriorated rapidly surgery was performed. A large intramural hematoma along the full length of the esophagus with dissection of the muscular layers of the esophagus was found. MRI findings of this case are reported.
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Affiliation(s)
- A G Kamphuis
- Department of Radiology, University Hospital, Groningen, The Netherlands
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33
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Meulman N, Evans J, Watson A. Spontaneous intramural haematoma of the oesophagus: a report of three cases and review of the literature. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1994; 64:190-3. [PMID: 8117198 DOI: 10.1111/j.1445-2197.1994.tb02176.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Spontaneous intramural haematoma of the oesophagus is an uncommon condition which may follow rapid increases in intra-oesophageal pressure and is predisposed to by coagulation disorders. The characteristic clinical presentation and findings at radiology and endoscopy frequently result in misdiagnosis and confusion with more sinister pathology. Awareness of the condition and conservative treatment with correction of coagulation abnormalities, when present, are the mainstays of management. Spontaneous resolution invariably occurs, and the condition is rarely fatal unless surgical treatment is attempted.
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Affiliation(s)
- N Meulman
- Department of Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
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34
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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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35
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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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36
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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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37
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Mattioli S, Raspadori A, Di Simone MP, Brusori S, Vernacchia R, Gozzetti G. Dissection of the esophagus after dilatation of a cervical diaphragm. Surg Endosc 1992; 6:249-51. [PMID: 1465734 DOI: 10.1007/bf02498814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The authors report a case of a very large esophageal mucosal dissection observed during an esophagoscopy performed 7 days after dilatation of a cervical esophageal web. They treated this dissection by positioning an endoesophageal balloon which obtained the fast, overlapping closure of the torn mucosal layers and at the same time allowed both gastric drainage and enteral feeding via a pump.
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Affiliation(s)
- S Mattioli
- Clinica Chirurgica II, Università di Bologna, Italy
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38
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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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39
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Herbetko J, Delany D, Ogilvie BC, Blaquiere RM. Spontaneous intramural haematoma of the oesophagus: appearance on computed tomography. Clin Radiol 1991; 44:327-8. [PMID: 1760909 DOI: 10.1016/s0009-9260(05)81268-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- J Herbetko
- Department of Radiology, Southampton General Hospital
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40
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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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41
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Affiliation(s)
- J M Hanson
- Department of Surgery, Hope Hospital, Salford
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42
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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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43
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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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44
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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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45
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Abstract
Three cases of intramural haematoma of the oesophagus are reported. Two cases mimicked benign neoplasms of the distal oesophagus. One of these resembled a polypoid tumour; the other occurred in a patient with known achalasia. Two cases presented with chest pain and haematemesis, the third presented with dysphagia and odynophagia only. One case was truly spontaneous and two cases were thought to be secondary to trauma from food.
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Affiliation(s)
- J Herbetko
- Department of Radiology, Southampton General Hospital
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46
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47
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Malledant Y, Tanguy M, Artus M, Cardin JL, Campion JP, Launois B, Saint-Marc C. [Spontaneous rupture of the esophagus]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 1986; 5:128-33. [PMID: 3729088 DOI: 10.1016/s0750-7658(86)80094-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Eighteen patients (16 men and two women), aged 20 to 77 years, were admitted to the University hospital between 1973 and 1984 for a Boerhaave's syndrome. Fourteen over eighteen were more than forty years old. Other particular features were the frequency of alcoholism (11 patients) and the lack of preexisting gastrointestinal symptomatology. The cardinal symptom, pain, occurred in 17 cases. It was preceded in 10 subjects by vomiting. Subcutaneous emphysema was only found in five patients, but standard chest X-ray showed seven times a pneumomediastinum. Pleural effusion was present in 14 subjects. Thirteen patients underwent thoracotomy: five within 48 h (1 death) and eight after 48 h (4 deaths); two further deaths were due to withholding surgery, and a third by performing bipolar oesophageal exclusion at a late stage (8th day); six of these deaths were related to local infection. The clinical and radiological features of Boerhaave's syndrome are presented in a review of the literature; particular attention is paid to the various methods of treatment.
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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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50
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