Recurrent spontaneous esophageal dissection

Abstract

Introduction: Spontaneous esophageal dissection is a rare disorder of the esophagus.

Case description: We present what is believed to be the first reported case of recurrent esophageal dissection in a previously healthy 33-year-old man with chronic eosinophilic esophagitis. He had two episodes of spontaneous dissection of the midesophagus separated by a 5-month interval. Both episodes responded to treatment with endoscopic intervention. He has remained free of additional recurrences after definitive endoscopic therapy and oral steroid therapy. A complete description of the case, relevant radiologic imaging, and a review of the relevant literature are provided.

Discussion: Endoscopic therapy is an option for the management of recurrent esophageal dissection.

Figure 1.

CT chest scan demonstrating intramural dissection of the esophagus. Sections demonstrate intramural dissection of the esophagus. Lucency within the “true” esophageal lumen indicates a feeding tube.

Figure 2.

EGD performed during the patient's first hospitalization. Active extravasation of purulent fluid was noted on endoscopy (arrow).

Figure 3.

A, EGD 1 day before hospital admission. Note the tracheal pattern of the esophagus, which is suggestive of eosinophilic esophagitis. B, EGD before hospital discharge. Note the significantly decreased trachealization of the esophagus (a). A pinhole defect was noted in the cervical esophagus; pre (b) and post endoclip placement (c).