Intramural rupture of the oesophagus is a rare form of spontaneous rupture intermediate between those of the Boerhaave and Mallory-Weiss syndromes. It is associated with vomiting, but the tear passes deep to the mucosa and does not reach to the surface of the oesophagus. A large intramural haematoma may develop that can compromise the lumen of the oesophagus with subsequent dysphagia.
Clinically, the patient may complain of severe retrosternal or back pain. Distinction from Boerhaave's syndrome is made radiologically: chest X-ray is normal and there is no barium leak. Diagnosis is confirmed at endoscopy.
Treatment is conservative; if tolerated, analgesia and fluids by mouth.
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