title: Combined esophageal injury complicated by progression to a second perforation: a case report.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.forename: Andreas
authors.initials: A
authors.lastname: Krieg
authors.forename: Christoph
authors.initials: C
authors.lastname: Vogt
authors.forename: Uwe
authors.initials: U
authors.lastname: Ramp
authors.forename: Ludger W
authors.initials: LW
authors.lastname: Poll
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Brinkmann
authors.forename: Edwin
authors.initials: E
authors.lastname: Bölke
authors.forename: Wolfram T
authors.initials: WT
authors.lastname: Knoefel
authors.forename: Matthias
authors.initials: M
authors.lastname: Peiper