[Intramural rupture and intramural hematoma of the esophagus: 3 case reports and literature review].

Together with three of our own observations of intramural rupture (IRO) or hematoma (IHO) of the esophagus, we have analyzed 91 case reports from the literature. Precipitating factors were identified in 63% of all patients. Most frequently potentially traumatic events such as vomiting (22%) or instrumentation (17%) preceded IRO/IHO. In 21% there were disturbances of hemostasis, either alone (15%) or in addition to a traumatic event (6%). 37% of IRO/IHO were spontaneous. In 35% the typical clinical triad of acute retrosternal pain, odynophagia or dysphagia and hematemesis was complete; in 46% only two out of three symptoms were present. IRO/IHO was managed conservatively in 84% of the patients, whereas 9% required surgery for complications. 7% were operated on without a precise indication. One patient died following surgery for endoscopic perforation. The rare syndrome of IRO/IHO must be considered in patients with acute retrosternal pain. Treatment is primarily conservative and the prognosis is excellent.