Esophageal Submucosal Hematoma Possibly Caused by Gastric Tube Insertion Under General Anesthesia

Abstract

We present a case of an esophageal submucosal hematoma that developed after endovascular treatment for coil embolization for an unruptured cerebral aneurysm. The patient had received antiplatelet therapy before surgery and anticoagulation therapy during surgery. The orogastric tube was removed at case end with sustained negative pressure. After surgery, the patient reported chest and back pain and was diagnosed with an esophageal submucosal hematoma. The hematoma might have been related to the gastric tube insertion or removal. Providers should keep in mind the possibility of this complication when a patient who was given antithrombotic therapy reports chest or back pain after surgery.

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

“…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].…”

Spontaneous Large Esophageal Lesion with Upper GI Bleed

“…36% patients present with the triad of retrosternal chest pain (due to esophageal distension by expanding hematoma), hematemesis and dysphagia or odynophagia, with 80% reporting at least 2 of these symptoms. 3 Dyspnoea is unusual but may occur from tracheal compression by the hematoma. In our case, the use of anticoagulants was the predisposing factor, with hematoma occurring either spontaneously or secondary to nasogastric tube insertion.…”

“…Repeated suctioning of nasogastric tube may produce negative pressure to the esophageal mucosa, leading to submucosal injury and consequent hematoma. 3 The most common site for hematoma is the distal esophagus (83%) followed by the middle esophagus (78%) and proximal esophagus (27%). Contrast swallow (barium or gastrograffin) typically shows a "double barrel esophagus" or "mucosal stripe" sign, and CT scan with intravenous contrast shows thickened esophageal wall with a non-enhancing, high-attenuation intramural mass causing luminal compromise.…”

Esophageal submucosal hematoma developed after endovascular surgery for unruptured cerebral aneurysm under general anesthesia: a case report

“…Sometimes, the causes are unknown [ 3 – 5 ]. The traumatic causes of esophageal submucosal hematoma include direct or blunt injury caused by medical apparatus inserted into the esophagus [ 6 ], insertion of gastric tube [ 7 ], and accidental swallowing of foreign objects. Most reported cases with esophageal submucosal hematoma were of patients receiving antiplatelet drugs or who had abnormal coagulation [ 6 – 8 ].…”

“…Direct damage to the mucosa by the nasogastric tube was considered unlikely, because the tube had been inserted into the stomach without resistance and that bloody secretion had not been aspirated from the tube before extubation. Fujimoto et al reported a case of esophageal submucosal hematoma possibly caused by gastric tube removal with sustained negative pressure [ 7 ]. In the present case, aspiration was performed only once before extubation.…”