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      Recurrent Spontaneous Esophageal Dissection

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          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.

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          Most cited references 13

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          Circumferential mucosal dissection and esophageal perforation in a patient with eosinophilic esophagitis.

          A young man with a previous history of episodes of mild solid food dysphagia was admitted with a total dysphagia. The esophagogastroduodenoscopy (EGDS) showed an extensive disruption of mucosal layer with a cul-de-sac in the lower part of the esophagus. Soon after the procedure, the patient suffered from an acute chest pain and subsequent CT scan demonstrated an intramural circumferential dissection of thoracic esophagus, and a mediastinal emphysema. An emergency right thoracotomy was performed, followed by a total esophagectomy with esophagogastroplasty and jejunostomy. The histopathology confirmed that mucosal and submucosal layers were circumferentially detached from muscular wall and showed an eosinophilic infiltration of the whole organ with necrosis and erosions of mucosal, submucosal and muscular layers. The diagnosis was esophageal perforation in eosinophilic esophagitis.
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            Endoscopic incision of a septum in a case of spontaneous intramural dissection of the esophagus.

            Intramural dissection of the esophagus is a rare esophageal disorder that is characterized by a long laceration between the esophageal mucosa and submucosa but without perforation. It reveals characteristic radiologic and endoscopic features. The etiology of intramural dissection of the esophagus remains uncertain. The most common presenting symptoms are sudden retrosternal pain, hematemesis, odynophagia, dysphagia, and back pain. Conservative management is usually thought to be adequate. We report a case of spontaneous intramural esophageal dissection, in which the symptom of dysphagia did not improve with the conservative management, and an endoscopic incision of the septum between true and false lumens using a needle-type diathermy knife was done safely and effectively.
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              Intramural esophageal dissection in a young man with eosinophilic esophagitis.

              Intramural esophageal dissection is a rare disorder that should be considered in patients presenting with chest pain, dysphagia, and hematemesis. Although most commonly occurring in elderly women with impaired coagulation, esophageal dissection has also been observed in other demographics including in those with eosinophilic esophagitis. In our report, we present the case of a 19-year-old man who was found to have an intramural esophageal dissection in the setting of undiagnosed eosinophilic esophagitis. There have been multiple, proposed management strategies; however, we implemented a nonoperative approach and obtained successful results. Intramural esophageal dissection is an important diagnosis for thoracic surgeons to be aware of as these patients often present as surgical emergencies, but often do not require an acute surgical intervention.
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                Author and article information

                Affiliations
                Department of Surgery, University of Texas Medical School at Houston, Houston, TX, USA.
                Department of Surgery, University of Texas Medical School at Houston, Houston, TX, USA.
                Michael E. DeBakey Institute for Comparative Cardiovascular Science and Biomedical Devices, Texas A & M University, College Station, TX, USA.
                Department of Surgery, University of Texas Medical School at Houston, Houston, TX, USA.
                Houston Endoscopy and Research Center, Houston, TX, USA.
                Digestive Associates of Houston, PA, Houston, TX, USA.
                Department of Cardiothoracic and Vascular Surgery, University of Texas Medical School at Houston, Houston, TX, USA.
                Author notes
                Address correspondence to: Shinil K. Shah, DO, Department of Surgery, University of Texas Medical School at Houston, 6431 Fannin Street, Houston, TX 77030. Telephone: (281) 841-6034, E-mail: shinil.k.shah@ 123456uth.tmc.edu
                Contributors
                Department of Surgery, University of Texas Medical School at Houston, Houston, TX, USA.
                Department of Surgery, University of Texas Medical School at Houston, Houston, TX, USA.
                ,
                Michael E. DeBakey Institute for Comparative Cardiovascular Science and Biomedical Devices, Texas A & M University, College Station, TX, USA.
                Department of Surgery, University of Texas Medical School at Houston, Houston, TX, USA.
                Houston Endoscopy and Research Center, Houston, TX, USA.
                Digestive Associates of Houston, PA, Houston, TX, USA.
                Department of Cardiothoracic and Vascular Surgery, University of Texas Medical School at Houston, Houston, TX, USA.
                Journal
                JSLS
                JSLS
                jsls
                jsls
                JSLS
                JSLS : Journal of the Society of Laparoendoscopic Surgeons
                Society of Laparoendoscopic Surgeons (Miami, FL )
                1086-8089
                1938-3797
                Apr-Jun 2014
                : 18
                : 2
                : 342-345
                4035651 JSLS-D-13-00125 10.4293/108680813X13693422518678
                © 2014 by JSLS, Journal of the Society of Laparoendoscopic Surgeons.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License ( http://creativecommons.org/licenses/by-nc-nd/3.0/us/), which permits for noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited and is not altered in any way.

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                Categories
                Case Reports

                Surgery

                case report, endoscopy, recurrent, spontaneous, esophageal dissection

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