Circumferential Esophageal Dissection Treated Conservatively in a Young Patient with Eosinophilic Esophagitis

Abstract

Eosinophilic esophagitis is an immune/antigen-mediated chronic esophagueal disease. The most frequent symptoms include dysphagia, food impaction, pain and gastroesophageal reflux. Endoscopic findings include esophageal rings, whitish exudates, longitudinal furrows, edema, esophageal narrowing and mucosal fragility, which may lead to complications such as esophageal perforation, mucosal tear or intramural dissection. Esophageal dissection is a rare entity mainly described in women receiving anticoagulant treatment or affected by coagulopathy; very few cases have been reported in patients with eosinophilic esophagitis, whether spontaneous or iatrogenic. We describe the case of a young 17-year-old male who suffered circumferential esophageal dissection as a consequence of a gastroscopy performed after presenting symptoms of food impaction and was subsequently diagnosed with eosinophilic esophagitis. As a result of the few cases reported thus far, there is not a unified standard of treatment for this complication; surgical, endoscopic and conservative treatments have been reported. In our case, the patient was successfully treated conservatively. In conclusion, this case report confirms the need to be extremely careful while performing endoscopy in EoE patients (including patients with suspected EoE) and the possibility to treat intramural circumferential esophageal dissection conservatively if perforation has been ruled out.