Spontaneous intramural rupture of the oesophagus.

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 ali patients.

Circumferential intramural esophageal dissection successfully treated by endoscopic procedure and metal stent insertion

“…3 Spontaneous intramural esophageal dissection tends to run long and deep and is usually located proximal to the gastroesophageal junction. 3,4 This type of injury was initially described in 1968 and 1970. 12,13 Although reports of esophageal hematoma are relatively common, only about 40 cases of spontaneous intramural esophageal dissection were identified among them.…”

“…[3][4][5][6][7][8][9] Although endoscopic treatments of spontaneous intramural esophageal dissection were reported in some patients, 3,10,11 their use in the management of circumferential intramural esophageal dissection has not been reported.In this article, we report a case of circumferential intramural esophageal dissection, in which initial conservative management failed to alleviate the patient's dysphagia. Several endoscopic treatments, including incision of the septum between the false and true lumens, transection of the true esophageal wall, balloon dilatation, and metal stent insertion, were performed in sequence.…”

“…[3][4][5][6][7][8][9] Although endoscopic treatments of spontaneous intramural esophageal dissection were reported in some patients, 3,10,11 their use in the management of circumferential intramural esophageal dissection has not been reported.…”

Esophagus: anatomy and developmental and structural anomalies

“…Tubular duplications may communicate at both ends with the esophageal lumen or be closed at one end, but more than 80% do not communicate with the lumen [76][77][78]217]. Spontaneous submucosal dissection of the esophagus has been reported and can radiographically present with a double-barrel esophagus that mimics a tubular duplication [79]. Surgical resection is usually recommended for definitive treatment and pathological diagnosis [80][81][82].…”

Outcomes following Boerhaave's syndrome

“…Non-operative management has been reported in selected cases without pleural contamination or where there has been a delay in presentation. [6][7][8] With the increasing trend of subspecialisation, this study aimed to analyse outcomes in patients with Boerhaave's syndrome who were treated in a specialist oesophagogastric surgical unit.…”