The spectrum of emetogenic injury to the esophagus and stomach

Intramural hematoma of the esophagus: Unusual complication of variceal sclerotherapy

“…Submucosal bleeding and intramural dissection of the esophageal wall, giving rise to an intramural hematoma, has been described as resulting from emetics [9][10][11][12][13][14][15][16], after ingestion of a foreign body and endoscopic instrumentation [17], following remote trauma [18], or as a spontaneous event in patients with impaired hemostasis such as in thrombocytopenia [13,15,19,20], in hemophiliacs [21], and in patients receiving anticoagulation therapy [14,15,17,22], as well as in patients with normal hemostasis [9,16,23,24]. In contrast to patients with a Mallory-Weiss laceration, who present with signs of upper gastrointestinal bleeding with or without pain [l 1], and patients with Boerhaave's syndrome, who present with excruciating pain in the thorax or upper abdomen, signs of circulatory collapse, and often subcutaneous or mediastinal emphysema [11], patients with intramural esophageal hematoma present with a sudden onset of a triad of symptoms: dysphagia, odynophagia, and hematemesis [13,15,24].…”

“…In contrast to patients with a Mallory-Weiss laceration, who present with signs of upper gastrointestinal bleeding with or without pain [l 1], and patients with Boerhaave's syndrome, who present with excruciating pain in the thorax or upper abdomen, signs of circulatory collapse, and often subcutaneous or mediastinal emphysema [11], patients with intramural esophageal hematoma present with a sudden onset of a triad of symptoms: dysphagia, odynophagia, and hematemesis [13,15,24]. Blood loss can be absent but is usually mild or moderate [15].…”

“…This appearance is often best shown on a lateral view since posterior hematomas are relatively common [9,12]. In some patients, the esophagogram reveals a "double-barrelled" esophagus, in which contrast material can be observed in both the true lumen of the esophagus and the intramural cav!ty [10,11,17,23]. Based on a review of 26 patients with esophageal hematoma, Shay et al [13] found that in patients with normal hemostasis, the hematoma always presented radiologically as a single lesion involving the distal esophagus.…”

Spontaneous rupture of distal oesophagus (Boerhaave’s syndrome) with unusual clinical presentation of pneumoperitoneum

“…Invariably, a detailed history-taking will uncover a cause-almost always vomiting (as recorded in this case). I use Thompson's (Silbert, 1978; Thompson, Ernst and Fry, 1967) designation of the emetogenic syndrome for the whole spectrum of cases of oesophageal trauma following vomiting. This is a far more meaningful term and I once again make a plea that the term 'spontaneous rupture' be discarded from the literature.…”

Spontaneous intramural rupture and intramural haematoma of the oesophagus.

“…12 The only death in the whole series occurred eight months after a misconceived emergency operation started in the abdomen and followed by total oesophagectomy at a time when only one case of intramural rupture, spontaneous or instrumental, had been reported, and that in a radiological journal. 9 Spontaneous intramural rupture of the oesophagus or spontaneous intramural dissecting haematoma is probably more common than is generally appreciated, and the diagnosis should be considered when the cause of acute pain in the chest or upper abdomen is not obvious. A carefully taken history provides the most important clues to the source of the trouble but the pain is so severe that most patients are in no mood to respond to detailed questioning, or they are too drowsy, having been given sedative drugs before admission.…”