特発性食道粘膜下血腫の1例

A case of intramural hematoma of the esophagus

特発性食道粘膜下血腫はまれな疾患であり，1957年William^1）が特発性食道粘膜下剝離として報告したもの，我が国では1982年Etani^2）らが報告したものが最初である。特発性食道粘膜下血腫は，Mallory-Weiss症候群や特発性食道破裂と一連の病態で起こるまれな疾患である。また，まれではあるが，致死的疾患である大動脈食道瘻との鑑別も重要となる。我々が経験した1例を，他疾患との鑑別点を含めて，文献的考察を加えて報告する。

We present a case report of an individual who exhibited an intramural hematoma of the esophagus（IHE）. A 72-year-old female patient complained of severe nausea and experienced episodes of hematemesis subsequent to undergoing otolaryngology surgery. Subsequently, we carried out an upper gastrointestinal endoscopy that revealed a sizable IHE spanning from the upper to lower regions of the esophagus. Moreover, contrast-enhanced CT scans demonstrated an asymmetrical esophageal wall thickening, a hyperdense and eccentric intramural hematoma, absence of extravasation, and mediastinal hematoma. Although the treatment of IHE is generally conservative, the prognosis is typically favorable, with complete resolution usually occurring within a few weeks. Nevertheless, it is important to note that IHE may coexist with aortoesophageal fistula or Boerhaave’s syndrome, and CT imaging can serve as an effective diagnostic tool in such scenarios.