[So-called spontaneous intramural dissection of the esophagus].
We report two cases of spontaneous esophageal intramural dissection in two women aged 65 and 79 years. Initial symptoms were a constrictive retrosternal thoracic pain during a meal. Minor hematemesis accompanied by dysphagia or odynophagia appeared during the following hours. After excluding a cardiovascular emergency, diagnosis was confirmed by upper GI endoscopy that found a large mucosal longitudinal dissection; the lesion extended from mid-esophagus until short above the gastro-esophageal junction. Intramural parietal dissection characteristically appeared on barium swallow as a "double-barrelled" esophagus related to a thin radiolucent mucosal membrane separating the false and true lumens. Medical treatment with total parenteral nutrition, intravenous gastric antisecretory drugs, antibiotics in 1 patient was continued until symptoms disappeared; oral feeding was then started without incident. Follow-up endoscopic examinations confirmed complete healing. Regardless of etiology which remains speculative, spontaneous intramural dissection of the esophagus probably results from an intramural hematoma in most cases.
Mathieu
B
B
Service d'Hépato-Gastroentérologie, Hôpital Intercommunal de Fréjus-Saint-Raphaël, Fréjus.
Le Gall
P
P
Mourani
A
A
Marquand
A
A
Schaefer
J P
JP
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002637:Chest Pain / Q000209:etiology; D003937:Diagnosis, Differential; D004935:Esophageal Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000628:therapy; D004945:Esophagoscopy; D005260:Female; D005500:Follow-Up Studies; D006406:Hematoma / Q000175:diagnosis / Q000000981:diagnostic imaging; D006801:Humans; D010289:Parenteral Nutrition, Total; D011859:Radiography; D012422:Rupture, Spontaneous; D013997:Time Factors
D000900:Anti-Bacterial Agents