Submucosal esophageal abscess evolving into intramural submucosal dissection: A case report

Abstract

BACKGROUND Here we report a rare case of submucosal esophageal abscess evolving into intramural submucosal dissection. CASE SUMMARY An 80-year-old woman was admitted to our emergency department with a chief complaint of dysphagia and fever. Laboratory tests showed mild leukocytosis and elevated C-reactive protein level. Computed tomography showed thickening of the esophageal wall. Upper endoscopy showed a laceration of the esophageal mucosa and a submucosal mass. Spontaneous drainage occurred, and we could see purulent exudate from the crevasse. We closed the laceration with endoscopic clips. The patient did not remember swallowing a foreign body; however, she ate crabs before the symptoms occurred. We prescribed the patient with antibiotic, and the symptoms were gradually relieved. Two months later, upper endoscopy showed that the laceration was healed, and the submucosal abscess disappeared. However, intramural esophageal dissection was formed. We performed endoscopic incision of the septum using dual-knife effectively. CONCLUSION In conclusion, we are the first to report the case of esophageal submucosal abscess evolving into intramural esophageal dissection. The significance of this case lies in clear presentation of the evolution process between two disorders. In addition, we recommend that endoscopic incision be considered as one of the routine therapeutic modalities of intramural esophageal dissection.

Diagnostic Dilemma: Infective Endocarditis in the Setting of an Esophageal Abscess

“…An intramural esophageal abscess is rare and typically develops secondary to esophageal mucosal injury [1]. Injury is usually traumatic, secondary to foreign bodies or instrumentation [2,3]. An esophageal abscess is not classically associated with infective endocarditis (IE) or bacteremia.…”