Abstract
Spontaneous intramural rupture or intramural haematoma of the oesophagus is a rare cause of acute pain in the chest and upper abdomen. Much less ominous than spontaneous complete rupture from which it must be distinguished, it seldom if ever necessitates operation. Five new cases are described and reviewed together with 15 collected from published reports. The dominant symptom of every case was severe and constant retrosternal or epigastric pain; concomitant dysphagia was mentioned in 11 cases. In seven the pain was preceded by or coincided with vomiting. The condition was related to other stresses in three and appeared to be truly spontaneous in 10. In approximately one-third of cases it started suddenly but more often it began as discomfort worsening rapidly. Fourteen patients vomited blood after experiencing pain but only four were given transfusions. In contradistinction to complete rupture, none had surgical emphysema and plain chest radiographs were unremarkable. All had abnormal gastrografin or barium swallows. Intramural haematomas with or without mucosal tears were seen in the 11 cases in which oesophagoscopy was performed. Fifteen patients made rapid and complete recoveries on conservative management. Of the four who did not respond satisfactorily, one had the oesophagus repaired, two had drainage of the mediastinum after failure to find the false lumen at thoracotomy, and one had only an abdominal exploration. The only death in the whole series occurred after a disastrous emergency exploration and subsequent total oesophagectomy.
Full text
PDF
Images in this article
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Bates M. Pressure rupture of the mid-thoracic oesophagus. Br J Surg. 1969 May;56(5):327–331. doi: 10.1002/bjs.1800560503. [DOI] [PubMed] [Google Scholar]
- Borrie J., Sheat J. Spontaneous intramural oesophageal perforation. Thorax. 1970 May;25(3):294–300. doi: 10.1136/thx.25.3.294. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Fráter L. L., Imre J., Horváth O. P., Rózsa Z. Intramurale Osophagusperforationen. Rofo. 1978 Dec;129(6):708–712. [PubMed] [Google Scholar]
- Joffe N., Millan V. G. Postemetic dissecting intramural hematoma of the esophagus. Radiology. 1970 May;95(2):379–380. doi: 10.1148/95.2.379. [DOI] [PubMed] [Google Scholar]
- Katz Z., Lancet M., Seligson-Singer S., Reznik R. [Asymptomatic bacteriuria in pregnant women]. Harefuah. 1974 Nov 1;87(9):390–394. [PubMed] [Google Scholar]
- Kelley D. L., Neugebauer M. K., Fosburg R. G. Spontaneous intramural esophageal perforation. J Thorac Cardiovasc Surg. 1972 Mar;63(3):504–508. [PubMed] [Google Scholar]
- LICHTER I., BORRIE J. INTRAMURAL OESOPHAGEAL ABSCESS. Br J Surg. 1965 Mar;52:185–188. doi: 10.1002/bjs.1800520308. [DOI] [PubMed] [Google Scholar]
- Marks I. N., Keet A. D. Intramural rupture of the oesophagus. Br Med J. 1968 Aug 31;3(5617):536–537. doi: 10.1136/bmj.3.5617.536. [DOI] [PMC free article] [PubMed] [Google Scholar]
- McMyn J. K. Spontaneous intramural oesophageal perforation. Australas Radiol. 1977 Sep;21(3):234–240. doi: 10.1111/j.1440-1673.1977.tb02957.x. [DOI] [PubMed] [Google Scholar]
- SANBORN E. B. Intramural abscesses of the esophagus: a complication of foreign bodies. J Thorac Cardiovasc Surg. 1960 May;39:586–592. [PubMed] [Google Scholar]
- Smith G., Brunnen P. L., Gillanders L. A., Teo H. S. Oesophageal apoplexy. Lancet. 1974 Mar 9;1(7854):390–392. doi: 10.1016/s0140-6736(74)93152-3. [DOI] [PubMed] [Google Scholar]
- Thompson N. W., Ernst C. B., Fry W. J. The spectrum of emetogenic injury to the esophagus and stomach. Am J Surg. 1967 Jan;113(1):13–26. doi: 10.1016/0002-9610(67)90251-6. [DOI] [PubMed] [Google Scholar]
- WILLIAMS B. Case report; oesophageal laceration following remote trauma. Br J Radiol. 1957 Dec;30(360):666–668. doi: 10.1259/0007-1285-30-360-666. [DOI] [PubMed] [Google Scholar]