[So-called 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 retrosternal thoracic pain during a meal. Minor hematemesis accompanied by dysphagia or odynophagia appeared during the following hours. After excluding a cardiovascular emergency, diagnosis was confirmed by upper GI endoscopy that found a large mucosal longitudinal dissection; the lesion extended from mid-esophagus until short above the gastro-esophageal junction. Intramural parietal dissection characteristically appeared on barium swallow as a "double-barrelled" esophagus related to a thin radiolucent mucosal membrane separating the false and true lumens. Medical treatment with total parenteral nutrition, intravenous gastric antisecretory drugs, antibiotics in 1 patient was continued until symptoms disappeared; oral feeding was then started without incident. Follow-up endoscopic examinations confirmed complete healing. Regardless of etiology which remains speculative, spontaneous intramural dissection of the esophagus probably results from an intramural hematoma in most cases.