Successful endoscopic internal drainage for infected intramural esophageal dissection complicated by mediastinal abscess: a case report

Background: Intramural esophageal dissection (IED) is a rare esophageal injury that is usually managed conservatively. However, the optimal treatment for complicated IED associated with infection or mediastinal abscess remains unclear.Case: A 57-year-old man with decompensated liver cirrhosis presented with chest pain, odynophagia, and fever. Chest computed tomography revealed IED complicated by mediastinal abscess. Despite conservative management and thoracoscopic drainage, persistent fever suggested inadequate drainage of the infected false lumen. Endoscopic internal drainage was performed by longitudinal mucosal incision, followed by enteral nutritional support via feeding jejunostomy. The patient recovered without major surgery. Six-month follow-up endoscopy demonstrated complete healing of the false lumen with restoration of a single esophageal lumen.Conclusions: Endoscopic internal drainage may be a feasible organ-preserving treatment option for selected patients with infected IED when adequate drainage cannot be achieved by conservative management or surgical drainage alone.