Spontaneous intramural dissection of the esophagus

We report two cases Of spontaneous esophageal intramural dissection in two women aged 65 and 79 years. Initial symptoms were a constrictive retrostern al thoracic pain during a meal Minor hematemesis accompanied by dysphagia o r odynophagia appeared-during the following hours. After excluding a cardio vascular emergency, diagnosis was confirmed by upper GI endoscopy that foun d a large mucosal longitudinal dissection; the lesion extended from mid-eso phagus until short above the gastro-esophageal junction. Intramural parieta l dissection characteristically appeared on barium swallow as a "double-bar relled" esophagus related to a thin radiolucent mucosal membrane separating the false and true lumens. Medical treatment with total parenteral nutriti on, intravenous gastric antisecretory drugs, antibiotics in 1 patient was c ontinued until symptoms disappeared; oral feeding was then started without incident. Follow-up endoscopic examinations confirmed complete heeling. Regardless of etiology which remains speculative, spontaneous intramural di ssection of the esophagus probably results from an intramural hematoma in m ost cases.