Extensive intramural esophageal dissection: An unusual endoscopic complication

摘要

A 72-year-old man was admitted to the hospital for a work-up of dysphagia. He had a history of Barrett's esophagus diagnosed a year before admission. EGD showed a grossly normal duodenum, diffusely erythematous stomach, and Barrett's epithelium involving the mid-to-distal esophagus (A). Three cold biopsy specimens from the mid-esophagus and 2 cold biopsy specimens from the distal esophagus were taken by using 2.45-mm Olympus Alligator Jaw forceps under direct visualization. After the procedure, the patient developed acute chest pain, worsening dysphagia, and hematemesis. A CT scan of the chest and abdomen showed an extensive dissecting intramural esophageal he-matoma beginning at the level of T1 and extending inferiorly to the level of the stomach (B and C). An esophagram showed no evidence of leakage but showed narrowing at the gastroesophageal junction consistent with intramural hema-toma (D). The patient was successfully managed conservatively with a nothing by mouth regimen, empiric antibiotics, and hemodynamic support in the intensive care unit.