Published online Dec 26, 2021. doi: 10.12998/wjcc.v9.i36.11467
Peer-review started: July 31, 2021
First decision: September 4, 2021
Revised: September 17, 2021
Accepted: November 14, 2021
Article in press: November 14, 2021
Published online: December 26, 2021
Processing time: 145 Days and 2.5 Hours
Intramural esophageal dissection (IED) is a rare disease that should be considered in patients with chest pain, dysphagia, and hematemesis. Although it occurs most frequently in older adult women with impaired coagulation or as a sequela of endoscopy, the incidence of spontaneous IED without an obvious causative agent has risen gradually.
This report describes a case of extensive annular IED in a 75-year-old male patient who presented with dysphagia for the past month. Esophageal barium meal radiography revealed slow passage of diluted iohexol through the esophagus after swallowing, prominent luminal dilation, obstruction of the lower segment with only a small amount of contrast medium entering the gastric cavity, and no obvious extravasation. Gastroscopy revealed smooth esophageal mucosa; several esophageal mucosal bridges and webbed mucosa were observed approximately 22 cm from the incisor. The mucosal surface was occasionally rough and uneven, and the length of the esophageal mucosal defect exceeded 10 cm. The anatomy was considered to be annular because the mucosal bridge connecting the proximal and distal tube was not attached to the surrounding myotubes. The final diagnosis was spontaneous extensive annular IED. We treated the patient successfully using endoscopic esophagotomy, which completely relieved the symptoms without complications.
Spontaneous annular IED can be treated successfully by endoscopic resection of the mucosal septum between the true and false lumen.
Core Tip: Intramural esophageal dissection (IED) is a rare entity characterized by mucosal rupture resulting in a false cavity. Herein, we presented a rare case of spontaneous annular IED that was treated successfully by endoscopic resection of the mucosal septum between the true and false lumina without complications, resulting in complete symptomatic relief. Physicians should consider IED, especially in elderly patients, after excluding other thoracic emergencies. This study indicates that endoscopic treatment may be effective in treating annular IED, without complications and aid clinicians in selecting the most suitable treatment, depending on the patient’s condition and type of lesion.