Eosinophilic esophagitis (EoE) is a chronic immune-mediated esophageal disease, with a rising incidence in childhood. The diagnosis is confirmed by esophageal mucosa eosinophil-predominant inflammation. Rare complications, such as intramural esophageal dissection (IED) due to progressive transmural inflammatory and fibrotic process, may occur in young adults. While severe cases can require immediate surgical intervention, conservative management may be also effective, as recently reported by Ibáñez-Sanz et al., decreasing the risk of surgery-related complications.