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Case Reports
. 2022 Jun 24;16(2):413-417.
doi: 10.1159/000525278. eCollection 2022 May-Aug.

Pan-Esophageal Submucosal Dissection following Transesophageal Echocardiography

Abdulrahman Qatomah  1 , Jonathan Cools-Lartigue  2 , Emmanuel Moss  3 , Jonathan Wyse  4 , Corey S Miller  4
Affiliations
Case Reports

Pan-Esophageal Submucosal Dissection following Transesophageal Echocardiography

Abdulrahman Qatomah et al. Case Rep Gastroenterol. .

Abstract

A 73-year-old female underwent open mitral valve replacement with transesophageal echocardiography (TEE) guidance. She developed upper gastrointestinal bleeding postoperatively and was found on upper endoscopy to have a bleeding site at the gastric cardia with the appearance of focal trauma and a possible puncture site. A submucosal bluish protrusion was seen throughout the esophagus with a mucosal flap at the proximal esophagus. As a unifying diagnosis, it was suspected that the intraoperative TEE probe caused a submucosal dissection with point of entry at the proximal esophagus, running the entire length of the esophagus and exiting at the gastric cardia, giving rise to a clinical upper gastrointestinal bleed. Closure of the esophageal defect was achieved using an endoclip. A CT scan showed focal pneumomediastinum along the proximal esophagus, confirming the hypothesis. We report the first case to our knowledge of iatrogenic pan-esophageal submucosal dissection, which, in this case, presented as a clinical bleed from the exit point trauma to the gastric cardia mucosa caused by a TEE probe. Endoscopic management of the gastric injury as well as the esophageal defect led to resolution of the bleeding and avoidance of mediastinitis, respectively, allowing for an excellent recovery.

Keywords: Dissection; Esophagus; Gastrointestinal bleeding; Transesophageal echocardiography; Upper endoscopy.

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Figures

Fig. 1
Fig. 1
Gastric cardia defect with appearance of possible puncture site.
Fig. 2
Fig. 2
Suspected submucosal abnormality with bulging and bluish discoloration in the mid esophagus.
Fig. 3
Fig. 3
Mucosal flap at the proximal esophagus with a false tract into the submucosal space (Right) and normal esophageal lumen (Left).
Fig. 4
Fig. 4
CT scan of thorax (axial) with pneumomediastinum.
See this image and copyright information in PMC

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