# A case of intramural esophageal dissection caused by vomiting during barium esophagography

## TL;DR

A 70-year-old man developed an esophageal injury during a medical test, which was later managed without surgery and healed over time.

## Contribution

This case report highlights intramural esophageal dissection caused by vomiting during barium esophagography, a rare complication.

## Key findings

- Intramural esophageal dissection occurred during barium esophagography due to vomiting in a patient being evaluated for esophageal cancer.
- Conservative treatment with fasting led to symptom resolution and healing of the esophageal wound.
- Follow-up endoscopy showed epithelialization at the entry site and complete healing of the injury.

## Abstract

Intramural esophageal dissection is a rare disease characterized by a laceration of the submucosal layer in the esophageal wall due to mechanical damage or esophageal pressure, resulting in the separation of the mucosal layer from the muscularis layer. This report presents a case of intramural esophageal dissection induced by vomiting during barium esophagography in a 70‐year‐old man undergoing evaluation for esophageal cancer. Preoperative assessments included endoscopic biopsies and the placement of a marking clip, followed by barium esophagography. During the procedure, the patient experienced vomiting and subsequent neck‐chest pain. Computed tomography revealed a barium‐filled dissection cavity within the esophagus. Esophagogastroduodenoscopy identified submucosal dissection proximal to esophageal cancer, exposing the muscularis layer and the entry site was at the same level as the biopsy site. The patient was treated conservatively with fasting, leading to symptom resolution. Follow‐up endoscopic evaluations confirmed that the entry site remained open but epithelialized, and the esophageal wound had healed.