Journal List > Korean J Gastroenterol > v.60(4) > 1007008

Cha, Kim, Kwon, Kim, Oh, Ryu, Kim, and Moon: A Case of Conservatively Resolved Intramural Esophageal Dissection Combined with Pneumomediastinum

Abstract

Intramural esophageal dissection (IED) is a rare form of esophageal injury. We report a rare case of spontaneous IED complicated with pneumomediastinum and successfully improved by conservative management. A 46-year-old man presented to the emergency department with chest pain and hematemesis. The endoscopic diagnosis was suspicious of IED. Chest CT scan performed to rule out complication noted IED combined with pneumomediastinum. He was managed conservatively with nil per oral, intravenous antibiotics and parenteral nutrition. Follow up study after 2 weeks later showed near complete resolution of IED. IED should be included in the differential diagnosis for unexplained acute chest pain, especially, associated with dysphagia and hematemesis. IED with pneumomediastinum or mediastinitis require prompt surgery. So far, there is no case report of IED combined with pneumomediastinum which resolved without surgical treatment. In this case, IED combined with pneumomediastinum has improved by conservative management, so we present a case report.

Figures and Tables

Fig. 1
Endoscopic finding of the esophagus on admission. One ovoid discrete esophageal ulcer was noted at 24 cm from the incisor.
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Fig. 2
Chest CT scans in the axial (A) and coronal (B) planes on admission. Esophageal wall thickening with a eccentric intramural mass and free air (asterisk) were noted within the mediastinum.
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Fig. 3
Chest CT scans in the axial (A) and coronal (B) planes on 2 weeks later. Near complete resolution of the esophageal wall thickening and the pneumomediastinum were noted.
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Fig. 4
Endoscopic finding of the esophagus on 6 weeks later. Near complete resolution of the esophageal ulcer was noted.
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Notes

Financial support: None.

Conflict of interest: None.

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