Dissecting intramural haematoma of the oesophagus

A systematic analysis of all the cases of dissecting intramural haematoma o f the oesophagus (DIHO) reported in the worldwide literature reveals that t his is essentially a benign condition. Eighty per cent of patients have at least two of the three typical presenting features of chest pain, haemateme sis and dysphagia or odynophagia. Forty-nine per cent of cases are associat ed with sudden pressure changes within the oesophagus (e.g. due to swallowi ng) or secondary to direct trauma to the oesophagus. A further group appear s to arise spontaneously and may be associated with underlying abnormal pre ssure changes within the oesophagus or a bleeding tendency. Awareness of th e condition prevents the pain being mistakenly attributed to a cardiac caus e. With conservative management the symptoms usually resolve within 2 weeks of presentation. The only mortality associated with DIHO is due to operati ve intervention or where there is another underlying life-threatening condi tion. (C) 2000 Lippincott Williams & Wilkins.