A Case of a Large, Gastric Intramural Hematoma Caused by Endoscopic Mucosal Resection, and Treated with Transcatheter Arterial Embolization

Abstract

Only two cases of gastric intramural hematoma (IMH) caused by endoscopic mucosal resection (EMR) have been reported to date. This is the first reported case of gastric IMH caused by EMR, treatment of which required hemoclipping and transcatheter arterial embolization. The patient had a normal coagulation profile and no relevant medical history. About 8 h after completing the EMR, the patient vomited approximately 150 mL fresh blood and complained of abdominal pain. Endoscopy showed a 3 × 7 cm hematoma with active surface bleeding in the gastric antrum. Hemoclipping of the bleeding site on the surface and transcatheter arterial embolization of the left gastric artery were performed. Thereafter, conservative management including administration of a proton pump inhibitor was performed, and the lesion resolved. A review of relevant previous cases and this case suggested vessel damage secondary to the submucosal injection itself to be a reasonable causative mechanism for the gastric IMH.

An Extremely Rare Association of Alcohol-Induced, Necrotizing, Acute Pancreatitis and Giant Dissecting Hematoma of the Gastric Wall with Hemorrhagic Shock: a Case Report

“…Thus, GPE may be considered not only a rare entity but also an exceptional event. The first case of an intramural gastric hematoma was described in 1838 as an occasional autoptic finding [9], and the first surgical description of gastric dissecting hematoma was reported 100 years later by Oppenheimer [10]. As far as we know, our case is the fifth case of intramural hematoma of the gastric wall that is associated with acute pancreatitis.…”

Gastric intramural hematoma subsequent to thoracic aortic dissection: Case report and literature review

“…The endoscopy-related cases include post-percutaneous endoscopic gastrostomy (PEG), argon plasma coagulation (APC), endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), EUS-guided fine needle aspiration (EUS-FNA) and post-injection therapy [ 6 , 7 , [14] , [15] , [16] , [17] , [18] , [19] ]. Furthermore, there are few reports with anedoctal causes for GIH, such as foreign body, peptic ulcer disease, amyloidosis and pancreatitis [ [20] , [21] , [22] , [23] , [24] ].…”

“…The treatment has a progressive spectrum. It can be conservative, resort to minimally invasive therapies (angiography, percutaneous drainage and endoscopic treatment) and/or to surgery [ 4 , [13] , [14] , [15] , [16] , 18 , 23 , 28 ].…”

“…If there is active bleeding or a trend toward enlargement, transcatheter arterial embolization (TAE) may be indicated. However, it is only technically possible if contrast extravasation of the gastroparietal branch of the left gastric artery is identified [ 4 , 16 , 29 ].…”

“…The second GIH, which was consequential to an EUS-FNA, was treated with endoscopic band ligation in the bleeding spot [ 18 ]. Furthermore, Park et al [ 16 ] described a post-EMR GIH with combined therapeutics: endoscopic hemocliping in the resection wound and subsequenty TAE.…”