title: Spontaneous circumferential intramural esophageal dissection complicated with esophageal perforation and esophageal-pleural fistula: a case report and literature review.
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.
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: R Y
authors.initials: RY
authors.lastname: Zhu
authors.affiliation: Division of Esophageal and Upper Gastrointestinal Surgery, Department of Surgery, University of Hong Kong, Queen Mary Hospital, Hong Kong.
authors.forename: T T
authors.initials: TT
authors.lastname: Law
authors.affiliation: Division of Esophageal and Upper Gastrointestinal Surgery, Department of Surgery, University of Hong Kong, Queen Mary Hospital, Hong Kong.
authors.forename: D
authors.initials: D
authors.lastname: Tong
authors.affiliation: Division of Esophageal and Upper Gastrointestinal Surgery, Department of Surgery, University of Hong Kong, Queen Mary Hospital, Hong Kong.
authors.forename: G
authors.initials: G
authors.lastname: Tam
authors.affiliation: Division of Esophageal and Upper Gastrointestinal Surgery, Department of Surgery, University of Hong Kong, Queen Mary Hospital, Hong Kong. slaw@hku.hk.
authors.forename: S
authors.initials: S
authors.lastname: Law
mesh_terms: D000328:Adult; D004935:Esophageal Diseases / Q000150:complications* / Q000601:surgery; D004937:Esophageal Fistula / Q000209:etiology* / Q000601:surgery; D004939:Esophageal Perforation / Q000209:etiology* / Q000601:surgery; D016629:Esophagectomy; D006801:Humans; D008297:Male; D010995:Pleural Diseases / Q000209:etiology* / Q000601:surgery; D016156:Respiratory Tract Fistula / Q000209:etiology* / Q000601:surgery; D000072663:Spontaneous Perforation / Q000150:complications / Q000601:surgery