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Spontaneous perforation in the ringed esophagus.
1Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota 55901, USA.
Summary
A patient with a ringed esophagus experienced spontaneous esophageal perforation, a rare event. Conservative management was successful, suggesting it may be a viable option even for distal tears.
Area of Science:
- Gastroenterology
- Esophageal Diseases
- Medical Case Reports
Background:
- Esophageal perforation is a serious condition, often requiring surgical intervention, especially when located in the distal esophagus.
- A ringed esophagus is a rare anomaly associated with dysphagia, and its role in spontaneous perforation is not well-established.
- Differential diagnoses for dysphagia in ringed esophagus include gastroesophageal reflux disease (GERD) and eosinophilic esophagitis (EE).
Observation:
- A 54-year-old man presented with chest pain and was diagnosed with a large distal esophageal tear and free air in the mediastinum.
- Upper endoscopy revealed a ringed esophagus, but biopsies showed normal histology, excluding eosinophilic esophagitis.
- The patient's symptoms of GERD and dysphagia resolved with proton pump inhibitor therapy.
Findings:
- This case presents a rare instance of spontaneous esophageal perforation in a patient with a ringed esophagus and normal histology.
- Despite the distal location of the large tear, the patient successfully managed conservatively without surgical intervention.
- Resolution of GERD and dysphagia symptoms with proton pump inhibitors suggests a significant contribution of reflux to the patient's condition.
Implications:
- Spontaneous esophageal perforation in a ringed esophagus, even distally, may be amenable to conservative management.
- This case challenges the conventional surgical approach for distal esophageal perforations in select patients.
- Further research is warranted to understand the pathophysiology and optimal management strategies for esophageal perforations in the context of a ringed esophagus.