Esophageal apoplexy: Case report, review, and comparison with other esophageal disorders

doi:10.1016/0736-4679(91)90215-2

The Journal of Emergency Medicine

Volume 9, Issue 6, November–December 1991, Pages 437-443

https://doi.org/10.1016/0736-4679(91)90215-2 Get rights and content

Abstract

Esophageal injuries are potentially serious disorders requiring prompt recognition and management. In addition to the well-recognized Mallory-Weiss and Boerhaave's syndromes, there exists a condition of spontaneous intramural esophageal hemorrhage: esophageal apoplexy. A case of esophageal apoplexy is presented as well as an evaluation of clinical presentations based on a collected review of the 66 cases previously reported. In addition, esophageal apoplexy is contrasted with the Mallory-Weiss and Boerhaave's syndromes, focusing on distinguishing attributes of utility to the emergency practitioner.

References (64)

W.G. Heceta et al.
Esophageal obstruction due to intramuscular hematoma following pneumatic dilatation
Chest
(1976)
D.B. Jones et al.
Intramural hematoma of the esophagus—a complication of endoscopic injection sclerotherapy
Gastrointest Endosc.
(1986)
G. Smith et al.
Oesophageal apoplexy
Lancet
(1974)
D. Atefi et al.
Spontaneous intramural hematoma of esophagus
Gastrointest Endosc.
(1978)
A.H. Freeman et al.
Spontaneous intramural oesophageal haematoma
Clin Radiol.
(1988)
J. Herbetko et al.
Oesophageal haematoma: report of three cases
Clin Radiol.
(1988)
D.L. Kelley et al.
Spontaneous intramural esophageal perforation
J Thorac Cardiovasc Surg.
(1972)
N.W. Thompson et al.
The spectrum of emetogenic injury to the esophagus and stomach
Am J Surg.
(1967)
H.D. Watts
Postemetic hematomas: a variant of the Mallory-Weiss syndrome
Am J Surg.
(1976)
P.R. Hastings et al.
Mallory-Weiss syndrome: review of 69 cases
Am J Surg.
(1981)

S.Y. Han et al.

Perforation of the abdominal segment of the esophagus

Am J Roentgenol.

(1984)

J.L. Bradley et al.

Intramural hematoma (incomplete perforation) of the esophagus associated with esophageal dilatation

Radiology

(1979)

W.V. Van Steenbergen et al.

Intramural hematoma of the esophagus: unusual complication of variceal sclerotherapy

Gastrointest Radiol.

(1984)

D.E. Low et al.

Complete esophageal obstruction secondary to dissecting intramural hematoma after endoscopic variceal sclerotherapy

Am J Gastroenterol.

(1988)

O. Elkof et al.

Submucosal perforation of the esophagus in the neonate

Acta Radiol.

(1969)

F.A. Rabiah et al.

Intramural hematoma of the esophagus: an unusual complication of vagotomy

Am J Dig Dis.

(1968)

B. Benjamin et al.

Submucosal dissection of the oesophagus due to haemorrhage: a new radiographic finding

J Laryngol.

(1965)

B. Williams

Oesophageal laceration following remote trauma

Br J Radiol.

(1957)

J.J. Ackert et al.

Spontaneous intramural hematoma of the esophagus

Am J Gastroenterol.

(1989)

M. Andress

Submucosal haematoma of the oesophagus due to anticoagulant therapy: report of a case

Acta Radiol.

(1971)

J.E. Barone et al.

Conservative treatment of spontaneous intramural perforation (or intramural hematoma) of the esophagus

Am J Gastroenterol.

(1980)

L. Berliner et al.

Spontaneous intramural perforation of the esophagus: case report and review of the literature

Am J Gastroenterol.

(1982)

G. Biagi et al.

Spontaneous intramural haematoma of the oesophagus

Thorax.

(1983)

J. Borrie et al.

Spontaneous intramural oesophageal perforation

Thorax.

(1970)

T.C. Demos et al.

Spontaneous esophageal hematoma diagnosed by computed tomography

J Comput Assist Tomogr.

(1986)

S. Etani et al.

Obstructing esophageal hematoma mimicking cancer: a case report and experimental study

Jpn J Surg.

(1982)

N.J. Ferris et al.

Oesophageal apoplexy and polycythaemia vera

Med J Aust.

(1984)

N. Joffe et al.

Postemetic dissecting intramural hematoma of the esophagus

Radiology

(1970)

W.F. Kerr

Spontaneous intramural rupture and intramural haematoma of the oesophagus

Thorax

(1980)

G. Lamont et al.

Spontaneous intramural oesophageal dissection

Thorax.

(1985)

J.W.K. Lien et al.

Intramural esophageal bleeding in a hemodialysis patient

Can Med Assoc J.

(1974)

R.M. Lowman et al.

The roentgen aspects of intramural dissection of the esophagus: the mucosal stripe sign

Radiology

(1969)

Cited by (11)

Spontaneous intramural dissection of the esophagus
2006, Gastroenterologia y Hepatologia
La perforación intramural espontánea del esófago (PIEE) es un trastorno esofágico raro. Es una enfermedad benigna, que a pesar del aspecto endoscópico tan alarmante, tiene una buena respuesta al tratamiento conservador y un pronóstico excelente. Sin embargo, algunas situaciones requieren un tratamiento quirúrgico urgente: perforación con mediastinitis, sangrado masivo o absceso entre otras. La gastroscopia es una prueba fundamental para el diagnóstico, una vez garantizada la indemnidad del esófago mediante pruebas radiológicas (esofagograma con contraste hidrosoluble, tomografía computarizada, resonancia magnética). Exponemos el caso de una mujer de 42 años de edad, con dolor torácico agudo, disfagia y odinofagia, que sometemos a estudio radiológico y endoscópico. Ante la persistencia de la clínica y la duda diagnóstica (perforación esofágica transmural frente a quiste de duplicación esofágico complicado), se decide intervenir quirúrgicamente. El diagnóstico final fue de PIEE.
Spontaneous intramural dissection of the esophagus (SIDE) is an unusual clinical entity. It is a benign disease that, despite its alarming endoscopic appearance, usually responds well to conservative management and has an excellent prognosis. Nevertheless, some situations require emergency surgical treatment. These situations include esophageal perforation with mediastinitis, massive bleeding, and abscess, among others. Upper gastrointestinal endoscopy is a useful diagnostic test when radiological examinations (hydrosoluble contrast esophagogram, computed tomography, or magnetic resonance imaging) have excluded perforation. We present the case of a 42-year-old woman who was admitted to our hospital complaining of acute chest pain, dysphagia, and odynophagia. Because of the persistence of symptoms and diagnostic uncertainty (SIDE versus complicated esophageal duplication cyst) surgery was performed. The definitive diagnosis was SIDE.
Extensive spontaneous submucosal dissection of the esophagus: Long-term sequential endoscopic observation and treatment
2002, Gastrointestinal Endoscopy
Citation Excerpt :
The terminology for this disease entity has varied widely including intramural rupture,1,5 esophageal apoplexy,6,7 submucosal or intramural dissection,8-11 and intramural hematoma.2,3 Spontaneous submucosal dissection of the esophagus can occur with or without mucosal laceration.1,7 The most common presenting symptom is severe central chest pain, which is too severe to differentiate from cardiovascular emergencies such as myocardial infarction and aortic dissection.1,3
Esophagogastric hematoma mimicking a malignant neoplasm: Clinical manifestations, diagnosis, and treatment
1998, Mayo Clinic Proceedings
Esophagogastric hematoma is a rare condition occurring spontaneously or after esophageal instrumentation. In this report, we describe a patient with acute dysphagia in whom a lower esophageal mass was detected radiographically. Upper endoscopy revealed an esophageal mass that extended from the mid-esophagus to the gastroesophageal junction and was associated with a malignant-appearing ulcerated mass (5 to 6 cm) in the cardia. Gastric cancer with esophageal extension was the presumptive diagnosis. Computed tomography showed that the esophageal mass had a density similar to blood, a finding suggesting the presence of an esophageal hematoma. Biopsy specimens of the ulcer revealed acute inflammation but no malignant involvement. The patient was treated conservatively, and the initial symptoms resolved. Esophagogastric hematomas can mimic a neoplasm; thus, establishing the correct diagnosis is important because this condition has a favorable prognosis, and only conservative treatment is needed.
Intramural esophageal dissection with eosinophilic esophagitis
2022, Clinical Journal of Gastroenterology
Dorsal mediastinal haemorrhage in dogs: 4 cases (2010–2018)
2022, Journal of Small Animal Practice
Intramural esophageal dissection as an esophageal emergency
2016, Chinese Journal of Radiology (Taiwan)

View all citing articles on Scopus

View full text

Clinical communicationEsophageal apoplexy: Case report, review, and comparison with other esophageal disorders

Abstract

Chest

Gastrointest Endosc.

Lancet

Gastrointest Endosc.

Clin Radiol.

Clin Radiol.

J Thorac Cardiovasc Surg.

Am J Surg.

Am J Surg.

Am J Surg.

Perforation of the abdominal segment of the esophagus

Am J Roentgenol.

Intramural hematoma (incomplete perforation) of the esophagus associated with esophageal dilatation

Radiology

Intramural hematoma of the esophagus: unusual complication of variceal sclerotherapy

Gastrointest Radiol.

Complete esophageal obstruction secondary to dissecting intramural hematoma after endoscopic variceal sclerotherapy

Am J Gastroenterol.

Submucosal perforation of the esophagus in the neonate

Acta Radiol.

Intramural hematoma of the esophagus: an unusual complication of vagotomy

Am J Dig Dis.

Submucosal dissection of the oesophagus due to haemorrhage: a new radiographic finding

J Laryngol.

Oesophageal laceration following remote trauma

Br J Radiol.

Spontaneous intramural hematoma of the esophagus

Am J Gastroenterol.

Submucosal haematoma of the oesophagus due to anticoagulant therapy: report of a case

Acta Radiol.

Conservative treatment of spontaneous intramural perforation (or intramural hematoma) of the esophagus

Am J Gastroenterol.

Spontaneous intramural perforation of the esophagus: case report and review of the literature

Am J Gastroenterol.

Spontaneous intramural haematoma of the oesophagus

Thorax.

Spontaneous intramural oesophageal perforation

Thorax.

Spontaneous esophageal hematoma diagnosed by computed tomography

J Comput Assist Tomogr.

Obstructing esophageal hematoma mimicking cancer: a case report and experimental study

Jpn J Surg.

Oesophageal apoplexy and polycythaemia vera

Med J Aust.

Postemetic dissecting intramural hematoma of the esophagus

Radiology

Spontaneous intramural rupture and intramural haematoma of the oesophagus

Thorax

Spontaneous intramural oesophageal dissection

Thorax.

Intramural esophageal bleeding in a hemodialysis patient

Can Med Assoc J.

The roentgen aspects of intramural dissection of the esophagus: the mucosal stripe sign

Radiology

Clinical communication
Esophageal apoplexy: Case report, review, and comparison with other esophageal disorders