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Gelu-Simeon M, Chuong AP, Saliba F, Thiery G, Laurent M, Vilain C, Borel M, Amaral L, Alexis M, Saint-Georges G, Saillard E. Submucosal hematoma: a new distinctive sign during emergency upper digestive endoscopy for ammonia ingestion. BMC Gastroenterol 2018; 18:92. [PMID: 29925326 PMCID: PMC6011402 DOI: 10.1186/s12876-018-0809-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 05/29/2018] [Indexed: 01/21/2023] Open
Abstract
Background Submucosal hematoma has never been associated with caustic injuries. Long-term follow-up of patients who ingested ammonia is not well known and ammonia ingestion is rare. Methods In a Single-center observational study, prospective data were collected from 2009 to 2013, in patients over the age of 14 years old referred for ammonia ingestion. The emergency and follow-up endoscopic data and the outcome were reported. Results Ammonia ingestion occurred in 43 patients. Submucosal hematoma of the gastric wall was a distinctive endoscopic sign observed in 15 (34.8%) cases. Oropharyngeal lesions were present in 30 (69.8%) patients, which was associated with ingestion with suicidal intent in 18 cases. Mild and severe endoscopic lesions (grade IIB to IIIB) were found in 16 (37.2%) cases with 10 (23.3%) cases presenting submucosal hematoma at initial endoscopy. A complete spontaneous gastric healing was frequently observed in 36 (83.7%) cases. In 11 cases with submucosal hematoma, a favourable outcome was observed with a medical treatment, however 6 of these patients had severe endoscopic lesions initially. Conclusions Submucosal hematoma of the gastric wall is an endoscopic sign occurring frequently in ammonia ingestion. Submucosal hematoma should be distinguished from necrosis in order to avoid false misclassification in favour of more severe lesions, which would lead to an abusive surgery. Electronic supplementary material The online version of this article (10.1186/s12876-018-0809-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Moana Gelu-Simeon
- CHU de Pointe-à-Pitre, Service d'Hépato-Gastro-Entérologie, Route de Chauvel, F-97159, Pointe-à-Pitre cedex, Guadeloupe, France. .,INSERM, UMR-S 1085/IRSET, F-35043, Rennes, France. .,Université Antilles-Guyane, Faculté de médecine Hyacinthe Bastaraud, F-97110, Pointe-à-Pitre Cedex, France.
| | - Anh-Phuc Chuong
- CHU de Saint-Pierre, Service d'Hépato-Gastro-Entérologie, F-97448, Saint-Pierre Cedex, La Réunion, France
| | - Faouzi Saliba
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, F-94800, Villejuif, France
| | - Guillaume Thiery
- CHU de Pointe-à-Pitre, Service de Réanimation, F-97139, Pointe-à-Pitre, Guadeloupe, France
| | - Marc Laurent
- CHU de Saint-Denis, Service d'Hépato-Gastro-Entérologie, F-97405, Saint-Denis, La Réunion, France
| | - Claire Vilain
- CHU de Pointe-à-Pitre, Service d'Hépato-Gastro-Entérologie, Route de Chauvel, F-97159, Pointe-à-Pitre cedex, Guadeloupe, France
| | - Marius Borel
- CHU de Pointe-à-Pitre, Service d'Hépato-Gastro-Entérologie, Route de Chauvel, F-97159, Pointe-à-Pitre cedex, Guadeloupe, France
| | - Leonardo Amaral
- CHU de Pointe-à-Pitre, Service d'Hépato-Gastro-Entérologie, Route de Chauvel, F-97159, Pointe-à-Pitre cedex, Guadeloupe, France
| | - Marceline Alexis
- CHU de Pointe-à-Pitre, Service d'Hépato-Gastro-Entérologie, Route de Chauvel, F-97159, Pointe-à-Pitre cedex, Guadeloupe, France
| | - Georgette Saint-Georges
- CHU de Pointe-à-Pitre, Service d'Hépato-Gastro-Entérologie, Route de Chauvel, F-97159, Pointe-à-Pitre cedex, Guadeloupe, France
| | - Eric Saillard
- CHU de Pointe-à-Pitre, Service d'Hépato-Gastro-Entérologie, Route de Chauvel, F-97159, Pointe-à-Pitre cedex, Guadeloupe, France
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