Intramucosal esophageal dissection after esophagogastroduodenoscopy: two case reports
- intramucosal esophageal dissection; pneumomediastinum; subcutaneous emphysema; mediastinitis; esophagogastroduodenoscopy
How to Cite
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Introduction: Intramucosal esophageal dissection (IED) is an uncommon disorder, described as the separation of the mucosa and/or submucosa from deeper muscular layers due to abrupt increase in intraesophageal pressure.
Case presentation: The first case il that of a 52 – years old female patient who underwent an esophagogastroduodenoscopy for control. After the procedure an extensive subcutaneous emphysema of the neck and a massive pneumomediastinum occurred. The patient was successfully treated with a conservative approach.
The second case is that of a 43-years old male patient affected by Down’s Syndrome, who underwent an esopagogastroduodenoscopy because of persisting dysphagia. The endoscopic showed the presence of a serrated stricture at 20 centimeters from dental arcade. After the procedure he fell dysphagia. A neck-chest TC-SCAN showed superior and posterior pneumomediastinum and subcutaneous emphysema, without signs of mediastinitis. The patient was successfully treated with conservative approach. After a few days, a new chest CT-SCAN showed the presence of an anomalous right subclavian artery arising from the descending part of the aortic arch, causing dysphagia lusoria.
Discussion: The causes of IED include iatrogenic instrumentation, hemostatic applications, mucosal injuries from ingestion of sharp foreign body, or spontaneous. A fluoroscopic upper gastrointestinal series or upper gastrointestinal endoscopy has been widely used to diagnose IED. CT and magnetic resonance are useful for differential diagnosis. In the absence of signs of mediastinitis management is conservative.
Conclusion: CT SCAN should be the first exam to perform in the suspicion of IED. The first line treatment should be conservative. In case of the onset of complications and in patients who are refractory to conservative management, endoscopic or surgical treatment are indicated.
- Agha R.A., Borrelli M.R., Farwana R., Koshy K., Fowler A., Orgill D.P., SCARE Group The PROCESS 2018 statement: updating consensus preferred reporting of case series in surgery [PROCESS] guidelines. Int. J. Surg. 2018;60:279–282.
- Phan GQ, Heitmiller RF. Intramural esophageal dissection. Ann Thorac Surg. 1997;63:1785-1786.
- Shay S, Berendson RA, Johnson LF. Esophageal hematoma. Four new cases, a review, and a proposed etiology. Dig Sci. 1981;26:1019-1024.
- 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;19:597e5-e7.
- Eun Kyung Khil, Heon Lee, Keun Her. 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;15:173-177.
- Soulellis CA, Hilzenrat N, Levental M. Intramucosal Esophageal Dissection Leading to Esophageal Perforation: Case Report and Review of the Literature. Gastroenterology & Hepatology 2008;4:362-365.
- Marks IJ, Keet AD. Intraluminal rupture of the esophagus. Br Med J. 1968; 3:536-537.
- Krishnama MS, Ramadan MF, Curtisa J. Intramural Esophageal dissection: CT imaging features. Eur J Radiol [extra] 2005;56:17-19.
- Kim SH, Lee SO. Circumferential intramural esophageal dissection successfully treated by endoscopic procedure and metal stent insertion. J Gastroenterol 2005; 40:1065-1069.
- Young CA, Menias CO, Bhalla S, Prasad SR. CT features of esophageal emergencies. Radiographics 2008;28:1541-1553.
- Hsu CC, Changchien CS. Endoscopic and radiological features of intramural esophageal dissection. Endoscopy 2001;33:379-381.
- Chiu HH, Lee SY. Intramural dissection of the esophagus endoscopic findings. J Intern Med Taiwan 2006;17:302-305.
- Kamphuis A, Baur C, Freling N. Intramural hematoma of esophagus: appearance on magnetic resonance imaging. Magn Reson Imaging. 1995;13:1037-1042
- Salomez D, Ponette E, Van-Steenberden W. Intramural hematoma of the esophagus after variceal sclerotherapy. Endoscopy. 1991;23:299-301.