A case of Esophageal submucosal dissection

Abstract

A 75 year-old female was admitted to our hospital complaining of hematemesis and chest pain after food ingestion. Urgent upper-endoscopy revealed the existence of esophageal submucosal hematoma with dissection extending the posterior wall of the entire esophagus. The esophagograms showed so-called double barrelled esophagus. The CT scan of the chest revealed thickening of the esophageal wall and air appearance beside the true esophageal lumen. Fasting and intravenous hyperalimentation were prescribed on admission. Her condition and the endoscopic findings improved immediately. The endoscopic examination on the 22 day of hospitalization showed that the elevated lesion had disappeared and the esophagograms also improved. She started to take meal, however, the symptoms did not relapse. Generally speaking, the prognosis of this disease is excellent under the conservative therapy. In this case, it seemed that a sudden rise of the internal pressure of the esophagus injured blood vessels in the submucosa and caused the submucosal hematoma.