Esophagogastroduodenal pneumatosis with subsequent pneumoporta and intramural duodenal hematoma after endoscopic hemostasis: a case report

Abstract

BackgroundEsophagogastroduodenal pneumatosis is the presence of air in esophagus, stomach, and duodenum simultaneously, which have never been described in the literature. Intramural duodenal hematoma (IDH) rarely occurs after endoscopic intervention. The diagnosis and treatment in both conditions are great challenge in daily practice.Case presentationA 70-year-old male patient, who had been taking warfarin for artificial valve replacement, developed IDH and esophagogastroduodenal pneumatosis after endoscopic hemostasis for duodenal ulcer bleeding. Initially, he had abdominal pain, gastrointestinal bleeding and hypotension. Later, he was found to have acute pancreatitis, biliary obstruction, gastric outlet obstruction and rapid decline of hemoglobin also ensued. The intramural duodenal hematoma and critical condition resolved spontaneously after conservative medical treatment.ConclusionBased on this case report, we suggest that intramural duodenal hematoma should be considered if a patient has the tetrad of pancreatitis, biliary obstruction, gastric outlet obstruction and rapid decline of hemoglobin after an endoscopic intervention. Those patients could be treated conservatively. But, surgery should be considered if the diseases progress or complications persist.

Oesophageal pneumatosis: computed tomographic characteristics in three dogs (2018–2021)

“…Increased intraluminal pressure could lead the gas to enter the oesophageal wall through small defects in the mucosa, reaching the submucosa or even the muscular layer. Documented cases describe this process during endoscopy or secondary to an obstruction of the alimentary tract (Huang et al., 2015 ; Katz et al., 1972 ; Tewari et al., 2017 ). Dissection of gas from an extra‐oesophageal source can occur in case of pneumomediastinum (Neal & Jha, 2020 ).…”