Management of Intramural Esophageal Dissection with Gastric Feeding Tube in an Alcoholic-hepatitis Patient

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Korean J Gastroenterol. 2016 Jan;67(1):35-38. Korean. Published online Jan 26, 2016. https://doi.org/10.4166/kjg.2016.67.1.35
Copyright © 2016 The Korean Society of Gastroenterology


Management of Intramural Esophageal Dissection with Gastric Feeding Tube in an Alcoholic-hepatitis Patient
Ryoung Eun Ko, Won Sik Jung, Yoon Chae Lee, Sung Hoon Choi and Seung Young Seo
Department of Internal Medicine and Research Institute of Clinical Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Korea.
Correspondence to: Seung Young Seo, Department of Internal Medicine, Chonbuk National University Medical School, 20 Geonji-ro, Deokjin-gu, Jeonju 54907, Korea. Tel: +82-63-250-2676, Fax: +82-63-254-1609, Email: bear7905@jbnu.ac.kr

Received August 31, 2015; Revised October 04, 2015; Accepted October 07, 2015.
This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract
Intramural esophageal dissection is a rare but clinically important condition in the field of gastroenterology. Classically, intramural esophageal dissection rarely occurs in patients who are anticoagulated or have poor medical condition, and its clinical presentation may include chest pain, dysphagia and hematemesis. Herein, we present a case of intramural esophageal dissection in an alcoholic hepatitis patient that was diagnosed by endoscopy and successfully treated with conservative management.


Keywords: Intramural esophageal dissection; Endoscopy; Esophagus; Gastric feeding tube

Figures


	Fig. 1 (A) Upper gastrointestinal endoscopy reveals large esophageal ulcer with mucosal defect on mid esophagus (38-40 cm form incisor) with large esophago-tracheal fistula formation. (B) After 1 week, gastric feeding tube insertion was performed. Upper gastrointestinal endoscopy reveals healing status of previous mucosal dissection with disappearance of fistula. (C) Follow up endoscopy performed 3 weeks after first upper gastrointestinal endoscopy shows markedly improved esophageal mucosal dissection, allowing removal of feeding tube. (D) After 5 weeks from first upper gastrointestinal endoscopy, intramural esophageal dissection has completely healed.
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	Fig. 2 (A) Chest CT reveals multiple air densities on the right side of esophageal mucosal defect extending to left artrium with mediastinitis which are findings compatible with esophageal dissection (arrow). (B) After 5 weeks, chest CT shows markedly improved mucosal dissection and absence of air density in the mediastinum.
	Click for larger image

Notes

Financial support:None.

Conflict of interest:None.

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