Esophageal Intramural Pseudodiverticulosis with Mallory-Weiss Syndrome: Report of a Case

Abstract

A 62-year-old man with a chief complaint of coughing up blood was revealed to have Mallory-Weiss syndrome with arterial bleeding by gastrointestinal endoscopy at the esophagogastric junction, and two teardrop-shaped fissures were found longitudinally extending into the muscle layer. Endoscopic treatment with ethanol injection and the administration of a thrombin solution spray failed to control the arterial bleeding. Hemostasis was finally archived by suturing the fissures under an open laparotomy. A postoperative barium esophagogram showed multiple flask-shaped outpouchings in the thoracic esophagus, and a diagnosis of esophageal intramural pseudodiverticulosis (EIPD) was thus made. EIPD is usually accompained with esophageal strictures but esophageal bleeding is rare.

Esophageal intramural pseudodiverticulosis improved by endoscopic dilatation

“…Endoscopic ultrasonography revealed thickening of the second sonographic layer of the esophagus. In addition, there was a small, round, low-echo spot and an acoustic shadow (arrowheads) indicating pseudodiverticula within the esophageal wall esophageal inflammation caused by candida infection, herpes virus infection, or reflux esophagitis [3,8,10]. In our case, candida infection accompanied the EIPD.…”

“…This disease was first reported as EIPD by Mendl in 1960 [1]. Since the first description, 240 cases have been reported in the international literature, and 45 cases have been reported from Japan [2][3][4][5][6][7].…”

“…This disease can occur at any age, although it is most frequently observed in middle-aged males [2,3,8,9]. Diverticula of patients with EIPD are small (∼1-5 mm in diameter), flask-like outpouchings extending from the esophageal lumen.…”

Esophageal Intramural Pseudodiverticulosis Treated by Balloon Dilatation: Report of a Case

“…2 Several reports have noted underlying diseases associated with EIPD, including diabetes mellitus, esophageal candidiasis, chronic alcohol abuse, and reflux esophagitis. 2,3 Our patient had no history of alcohol abuse or any other systemic diseases, and examinations Treatment of EIPD is not necessary unless symptoms are present, 4 and usually aims to relieve dysphagia, which is the predominant symptom in most cases. 5 When there is concomitant candidiasis, reflux esophagitis, or other mucosal disease, medical treatment of these disorders alone is often sufficient to relieve symptoms and reduce the pseudodiverticulosis.…”

Esophageal pseudodiverticulosis presenting with massive gastrointestinal bleed

“…The diverticuli do not involve the entire wall thickness, and they correspond to ductal dilatation of esophageal mucosal glands. 3,4 Endoscopy is the diagnostic test of choice, and these small diverticular openings can be missed in the absence of adequate air insufflation. 2 The pathophysiology of EIP remains unclear.…”