Esophageal Rupture as a Primary Manifestation in Eosinophilic Esophagitis

Table 1

Literature review of esophageal rupture in eosinophilic esophagitis.

Reference	Patient age	Previous diagnosis of EoE	Prior symptoms	Presentation	Imaging/endoscopy	Treatment
Lucendo et al. [10]	36	No	Intermittent esophageal symptoms since childhood with frequent episodes of choking; seasonal bronchial asthma and known sensitivity to mustard, peanuts, grasses, and olive pollen	Meat impaction resolved by inducing vomiting followed by intense retrosternal pain	CT with contrast showed extensive mediastinal and subcutaneous emphysema amongst other findings suggestive of perforation of esophagus; an endoscopy done 9 months later showed narrowing of middle esophagus with linear furrows and cobble stoning	Thoracotomy with closure of perforation
Lucendo et al. [10]	65	No	Several-year history of intermittent esophageal symptoms not requiring treatment	Intense abdominal pain after choking on a piece of plum which was relieved after inducing vomiting	Endoscopy at the time showed a deep ulcer in the distal third of the esophagus and a CXR showed a left pleural effusion and free air around the gastric fundus	Laparotomy with closure of perforation
Predina et al. [11]	19	No	Three-year history of dysphagia and seasonal allergies	Retching following dinner, followed by hematemesis and melena 14 hours later	Endoscopy revealed presence of two Mallory-Weiss tears just superior to GE junction and corrugation of esophagus	Endoscopic clipping with epinephrine injection
Quiroga et al. [12]	24	Yes	Allergy to pollen and an esophageal stricture in the middle third of the esophagus secondary to eosinophilic esophagitis	Progressive chest pain, nausea, vomiting, and fever	Spiral CT showed intramural circumferential dissection of thoracic esophagus and periesophageal mediastinal abscess formation	Conservative management with antibiotics and parental nutrition; corticosteroid therapy was initiated after abscess resolution was demonstrated on a CT
Robles-Medranda et al. [13]	9	No	History of asthma and intermittent solid food dysphagia	Chest pain, pyrosis, and fever after an episode of food blockage	CXR was normal; CT showed a retroesophageal perforation with periesophageal fluid collection	Conservative management with antibiotics
Riou et al. [14]	26	No	Long history of dysphagia and esophageal obstruction as a child and also had history of idiosyncratic reactions to champagne and red wine	Severe constant epigastric pain following food impaction	CXR confirmed air in cervical tissues and CT showed pneumomediastinum; gastrografin swallow showed free contrast in peritoneal cavity; subsequent endoscopy showed stenosis, circular rings, and an 8 cm long longitudinal tear on the right lateral wall of the esophagus	Subtotal esophagectomy and cervical esophagogastric anastomosis were performed
Giles et al. [15]	12	No	N/A	Sore throat, dysphagia with solids, and retrosternal pain that persisted after choking on a piece of corn	CT with IV contrast revealed a small contained perforation without mediastinitis or pleural effusion	Nonoperative management with broad spectrum antibiotics and total parental nutrition was used
Prasad et al. [16]	54	No	Intermittent history of solid food dysphagia, heartburn, and asthma	Presented with retrosternal pain after an episode of food impaction; he induced emesis to relieve the food impaction	CT demonstrates free air in the mediastinum with pleural effusions and inflammatory changes around the distal esophagus; upper endoscopy reveals a large tear in the distal esophagus	Conservative management with IV antibiotics and bowel rest
Spahn et al. [17]	41	No	History of multiple episodes of dysphagia	Presented with dysphagia 18 hours after ingesting acetaminophen	Esophagoscopy showed stricture and hemorrhage; CT showed mediastinal air consistent with perforation	Not mentioned
Cohen et al. [18]	56	No	History of heartburn, asthma, and seasonal allergies	Progressive nausea, vomiting, and epigastric and chest pain	CT scan revealed air and fluid surrounding the esophagus	Closure of the perforation
Gómez-Senent et al. [19]	35	No	N/A	Dysphagia, vomiting, and epigastric pain	Upper endoscopy revealed impacted bean; CT scan showed free liquid around esophagus and pneumomediastinum	Conservative management with antibiotics
Ligouri et al. [20]	32	No	Mild solid food dysphagia	Presented with food impaction	Upper endoscopy revealed mucosal disruption; CT scan showed circumferential dissection and mediastinal emphysema	Right thoracotomy, total esophagectomy with esophagogastroplasty, and jejunostomy
Straumann et al. [21]	28	No	Ten-year history of dysphagia	Severe vomiting and hematemesis	Upper endoscopy showed deep mucosal tear; CT scan showed pneumomediastinum	Surgery and antibiotics