発症前後の経過を観察し得た食道粘膜剥離症の1例

Abstract

A 54-year-old man suffered tonsillar pain, extending through the chest, resulting in an inability to eat or drink. Initial endoscopic examination showed a diffuse edematous swelling of the esophagus, with no abnormality in the mucosal surface. Inflammation or tumor of the esophagus was suspected, and conservative therapy was commenced. On the fourth day of hospitalization, the patient spat up some coagulated blood, after which his symptoms greatly improved. Esophageal endoscopy on the eighth day of hospitalization showed submucosal dissection in the upper part of the esophagus, with edema and bleeding in the false part of the esophagus. After endoscopic study, an upper GI series and CT were performed. These showed the false diverticulum in the esophagus, with no evidence of extravasation. Submucosal dissection of the esophagus was diagnosed, and conservative therapy continued. Endoscopic examination on the 16th day of hospitalization showed reduction of the edema and bleeding, with mucosal regeneration. Through such a clinical course, organic disease of the esophagus may occur before submucosal dissection.