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CASE REPORT
Year : 2018  |  Volume : 51  |  Issue : 5  |  Page : 198-200

Surgical versus conservative management for suppurative intramural esophageal dissection


1 Department of Thoracic Surgery, Chung Shan Medical University Hospital; School of Medicine, Chung Shan Medical University, Taichung, Taiwan
2 Department of Gastroenterology, Chung Shan Medical University Hospital, Taichung, Taiwan
3 School of Medicine, Chung Shan Medical University; Department of Gastroenterology, Chung Shan Medical University Hospital, Taichung, Taiwan

Correspondence Address:
Dr. Frank Cheau-Feng Lin
Department of Thoracic Surgery, Chung Shan Medical University Hospital, No. 110, Sec. 1, Jianguo N. Rd., Taichung 40201, Taipei
Taiwan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/fjs.fjs_160_17

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Often presented with an insidious onset, intramural esophageal dissection (IED) is a rare disease which has been mostly treated conservatively, though the treatment for infectious cases is still controversial. Two cases are reported here as follows: one was approached surgically by thoracoscopic mediastinotomy and neck debridement and the other was treated conservatively. The latter subsequently developed septic shock and was readmitted with intensive care. Both patients eventually recovered and resumed oral intake without requiring esophagectomy. Comparing these two cases of IED, one with a mucosal perforation and the other without, surgical intervention revealed the advantages of definitive isolation of pathogen and rapid mechanical removal of pus. Surgical risks should be evaluated against the severity, such as the presence of a mucosal perforation and the risk of a protracted clinical course for IED.


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