A Case of Idiopathic Gastroesophageal Submucosal Hematoma and Its Disappearance Observed by Endoscopy

Oe, Shinji; Watanabe, Tatsuyuki; Kume, Keiichiro; Shibata, Michihiko; Hiura, Masaaki; Yoshikawa, Ichiro; Harada, Masaru

doi:10.7888/juoeh.36.123

Cited by 10 publications

(25 citation statements)

References 12 publications

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“…In our patient, the nasogastric tube was placed smoothly into the stomach, there were no anatomical abnormalities of the esophagus, and suction was applied while its tip was in the stomach, not while it was in the esophagus. The most common location of IHE is in the distal esophagus (83%), as this area is not supported by enough surrounding structures [12,13]. The bleeding spot in our case was in the area of the mid-esophagus (28 cm from dental arch) which was around the second natural constriction site.…”

Section: Discussionmentioning

confidence: 78%

Nasogastric Tubes Can Cause Intramural Hematoma of the Esophagus

Yamada

Motomura²,

Hiraoka³

et al. 2019

Am J Case Rep

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Patient: Male, 84 Final Diagnosis: Intramural hematoma of esophagus Symptoms: Chest pain • hematemesis Medication: — Clinical Procedure: Esophagogastroduodenoscopy Specialty: Gastroenterology and Hepatology Objective: Diagnostic/therapeutic accidents Background: Intramural hematoma of the esophagus (IHE), a rare manifestation of acute mucosal injuries of the esophagus, can be caused by trauma such as endoscopic surgeries. Coagulation disorders increase the risk of IHE. The most common location of IHE is in the distal esophagus. The characteristic clinical triad of manifestations comprises acute retrosternal pain, odynophagia or dysphagia, and hematemesis. It is important to distinguish IHE from other acute conditions such as acute coronary syndrome, aortic dissection, and pulmonary embolism. Case Report: An 84-year-old male was scheduled for coil embolization for an endoleak after endovascular aneurysm repair. For this reason, he was taking aspirin and warfarin. A nasogastric tube had been inserted during surgery and subsequently removed without any problems reported. Postoperatively, he experienced chest pain and hematemesis of sudden onset. Urgent esophagogastroduodenoscopy demonstrated a large, dark red, non-pulsatile, submucosal, esophageal mass in the area of the mid-esophagus with a little oozing. He was diagnosed as having an IHE; other possible diagnoses were excluded by contrast-enhanced computed tomography and aortography. He was treated with fasting, a proton pump inhibitor, and cessation of anti-thrombotic drugs; he recovered completely. The bleeding spot in the esophagus was in the area of the mid-esophagus, which was around the second natural constriction site. It was possible that the nasogastric tube had contact with the esophageal wall at this second natural constriction, and caused intramural esophageal bleeding. Conclusions: Nasogastric tubes are not generally recognized as a cause of IHE. However, they can cause them, especially when a patient is taking anti-thrombotic drugs.

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Section: Discussionmentioning

confidence: 78%

Nasogastric Tubes Can Cause Intramural Hematoma of the Esophagus

Yamada

Motomura²,

Hiraoka³

et al. 2019

Am J Case Rep

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“…The thoracic oesophagus is dilated. The white arrow indicates the oesophagus good, and approximately 90% of reported cases receiving antiplatelet therapy had been treated conservatively with cessation of postoperative antiplatelet therapy [3][4][5][6][7][8][9].…”

Section: Discussionmentioning

confidence: 99%

Oesophageal submucosal hematoma after flow diverter embolization with favourable outcome treated by discontinuing postoperative antiplatelet therapy for only three days: a case report

et al. 2019

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Background: Oesophageal submucosal hematoma is a rare perioperative complication. When this complication develops after endovascular surgery, which requires postoperative antiplatelet therapy, whether to stop antiplatelet therapy or not is controversial. If antiplatelet therapy is discontinued, the appropriate time to resume antiplatelet therapy is unclear. Case presentation: A 75-year-old woman (height 134 cm, weight 37 kg) underwent flow diverter embolization for unruptured cerebral aneurysm under general anaesthesia. The patient received dual antiplatelet therapy before surgery and anticoagulation therapy intraoperatively. After surgery, the patient developed hematemesis and was diagnosed with oesophageal submucosal hematoma. Conservative treatment was initiated after discontinuing antiplatelet therapy, which was resumed 3 days after surgery. The patient showed good recovery even after the resumption of antiplatelet therapy. Conclusions: In our case, we successfully treated oesophageal submucosal hematoma developing after endovascular surgery with early resumption of postoperative antiplatelet therapy.

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“…[16] Increased bleeding tendency because of antiplatelet or AT is considered to be involved in the pathogenesis of submucosal hematoma. [17] The hematoma forms within the muscular layers and expands until its growth is limited by adjacent structures, which seldom causes hemorrhage into the mediastinum or peritoneal cavity. [18] In this case, the patient received antiplatelet and AT, which could have aggravated the risk of ISH.…”

Section: Discussionmentioning

confidence: 99%

Surgically treated rare intestinal bleeding due to submucosal hematoma in a patient on oral anticoagulant therapy

Yu¹,

Feng²,

Han³

et al. 2018

Medicine

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Rationale:Bleeding in the gastrointestinal tract is a common complication of oral anticoagulant therapy (AT), and it usually appears as mucosal erosion or ulcer; however, intestinal submucosal hematoma (ISH) is an uncommon cause of hemorrhage.Patient concerns:This report presents the case of a 70-year-old woman with acute hematochezia induced by AT. She underwent computed tomography and endoscopy.Diagnoses:Colon submucosal hematoma.Interventions:Conservative treatment had no effect, and the patient underwent emergency surgery.Outcomes:Surgical resection showed hemorrhage and necrosis in the left colon, and the patient recovered 24 hours after surgery and continued AT.Lessons:The present case indicates that the ISH should be kept in mind as a complication of AT. It can be managed conservatively in some stable patients, but emergency surgery may be needed in some serious situations.

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A Case of Idiopathic Gastroesophageal Submucosal Hematoma and Its Disappearance Observed by Endoscopy

Cited by 10 publications

References 12 publications

Nasogastric Tubes Can Cause Intramural Hematoma of the Esophagus

Nasogastric Tubes Can Cause Intramural Hematoma of the Esophagus

Oesophageal submucosal hematoma after flow diverter embolization with favourable outcome treated by discontinuing postoperative antiplatelet therapy for only three days: a case report

Surgically treated rare intestinal bleeding due to submucosal hematoma in a patient on oral anticoagulant therapy

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