1
|
Wheeler AW, Landreneau S. Disappearing Dysphagia and the Spontaneous Intraesophageal Hematoma. ACG Case Rep J 2024; 11:e01422. [PMID: 38994191 PMCID: PMC11239158 DOI: 10.14309/crj.0000000000001422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 05/31/2024] [Indexed: 07/13/2024] Open
Affiliation(s)
- A Wayne Wheeler
- Department of Internal Medicine, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Stephen Landreneau
- Department of Gastroenterology, Louisiana State University Health Sciences Center, New Orleans, LA
| |
Collapse
|
2
|
de Boer HH, O'Donnell C. An atypical case of fatal 'esophageal apoplexy': post-mortem findings and differential diagnosis. Int J Legal Med 2024:10.1007/s00414-024-03280-6. [PMID: 38926244 DOI: 10.1007/s00414-024-03280-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Accepted: 06/21/2024] [Indexed: 06/28/2024]
Abstract
Forensic pathologists need to have comprehensive knowledge of a large variety of causes of sudden natural death. We describe a case of sudden and unexpected death in woman in her sixties due to rupture of a large paraesophageal hematoma. The post-mortem examination and differential diagnosis are discussed. The combined findings of whole-body post-mortem CT imaging (PMCT), targeted PMCT angiography, autopsy, and histology are most in keeping with 'esophageal apoplexy'; a rare cause of hemorrhage in the esophageal wall. A review of the literature indicates that most cases of esophageal apoplexy are self-limiting and that fatal complications are exceedingly rare. Our case demonstrates that esophageal apoplexy can present as sudden unexpected death.
Collapse
Affiliation(s)
- Hans H de Boer
- Victorian Institute of Forensic Medicine / Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, VIC, 3006, Australia.
| | - Chris O'Donnell
- Victorian Institute of Forensic Medicine / Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, VIC, 3006, Australia
| |
Collapse
|
3
|
Oba J, Usuda D, Tsuge S, Sakurai R, Kawai K, Matsubara S, Tanaka R, Suzuki M, Takano H, Shimozawa S, Hotchi Y, Usami K, Tokunaga S, Osugi I, Katou R, Ito S, Mishima K, Kondo A, Mizuno K, Takami H, Komatsu T, Nomura T, Sugita M. Hemorrhagic shock due to submucosal esophageal hematoma along with mallory-weiss syndrome: A case report. World J Clin Cases 2022; 10:9911-9920. [PMID: 36186194 PMCID: PMC9516938 DOI: 10.12998/wjcc.v10.i27.9911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/08/2022] [Accepted: 08/17/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Esophageal submucosal hematoma is a rare condition. Although the exact etiology remains uncertain, vessel fragility with external factors is believed to have led to submucosal bleeding and hematoma formation; the vessel was ruptured by a sudden increase in pressure due to nausea, and the hematoma was enlarged by antiplatelet or anticoagulant therapy. Serious conditions are rare, with a better prognosis. We present the first known case of submucosal esophageal hematoma-subsequent hemorrhagic shock due to Mallory-Weiss syndrome.
CASE SUMMARY A 73-year-old female underwent endovascular treatment for an unruptured cerebral aneurysm. The patient received aspirin and clopidogrel before surgery and heparin during surgery, and was well during the surgery. Several hours after returning to the ICU, she complained of chest discomfort, vomited 500 mL of fresh blood, and entered hemorrhagic shock. Esophageal submucosal hematoma with Mallory-Weiss syndrome was diagnosed through an endoscopic examination and computed tomography. In addition to a massive fluid and erythrocyte transfusion, we performed a temporary compression for hemostasis with a Sengstaken-Blakemore (S-B) tube. Afterwards, she became hemodynamically stable. On postoperative day 1, we performed an upper gastrointestinal endoscopy and confirmed no expansion of the hematoma nor any recurring bleeding; therefore, we removed the S-B tube and clipped the gastric mucosal laceration at the esophagogastric junction. We started oral intake on postoperative day 10. The patient made steady progress, and was discharged on postoperative day 33.
CONCLUSION We present the first known case of submucosal esophageal hematoma subsequent hemorrhagic shock due to Mallory-Weiss syndrome.
Collapse
Affiliation(s)
- Jiro Oba
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Daisuke Usuda
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Shiho Tsuge
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Riki Sakurai
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Kenji Kawai
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Shun Matsubara
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Risa Tanaka
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Makoto Suzuki
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Hayabusa Takano
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Shintaro Shimozawa
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Yuta Hotchi
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Kenki Usami
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Shungo Tokunaga
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Ippei Osugi
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Risa Katou
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Sakurako Ito
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Kentaro Mishima
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Akihiko Kondo
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Keiko Mizuno
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Hiroki Takami
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Takayuki Komatsu
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
- Faculty of Medicine, Juntendo University, Bunkyo-ku 113-8421, Tokyo, Japan
| | - Tomohisa Nomura
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| | - Manabu Sugita
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
| |
Collapse
|
4
|
Intramural Esophageal Hematoma Mimicking Acute Coronary Syndrome: Complication of Warfarin Use in a Mechanical Heart Valve Patient. Case Rep Med 2022; 2022:5636989. [PMID: 35757464 PMCID: PMC9217597 DOI: 10.1155/2022/5636989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 05/04/2022] [Indexed: 11/18/2022] Open
Abstract
A 59-year-old female with a history of mitral valve replacement presented to emergency department, complaining of sudden-onset retrosternal chest pain since 4 hours ago. Electrocardiogram, laboratory tests, and computed tomography (CT) angiography of aorta were performed and ruled out aortic dissection and cardiovascular events. However, new complaint of odynophagia, dysphagia, and incidental findings in CT angiography proposed esophageal pathologies. After initial workup including upper gastrointestinal endoscopy, intramural esophageal hematoma was diagnosed. Laboratory tests revealed significant reduction in the hemoglobin level. Management of warfarin-induced major bleeding in a patient whom anticoagulation was necessary for the prevention of mechanical heart valve thrombosis was challenging. The patient recovered fully with conservative treatment and was discharged on hospital day 14 with low molecular weight heparin. We described a case of intramural esophageal hematoma as a rare condition that could be misdiagnosed as a cardiovascular emergent disease and would be worsened by antiplatelet and anticoagulation therapy. Accordingly, it is important to differentiate intramural esophageal hematoma from cardiac ischemic events. Another challenge was correction of coagulation in the presence of mechanical mitral valve. Fortunately, we had a favorable outcome following conservative management.
Collapse
|
5
|
Computed Tomography Imaging of Iatrogenic Esophageal Injuries. J Comput Assist Tomogr 2022; 46:355-362. [PMID: 35297793 DOI: 10.1097/rct.0000000000001283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Knowledge of iatrogenic esophageal injuries is important given the variety of etiologies, including medical instrumentation (eg, endoscopes), radiotherapy, and anticoagulation. The clinical presentation and imaging findings of esophageal injuries depend on the mechanism and location of the injury. Imaging modalities commonly used for the evaluation of esophageal injuries include esophagram and computed tomography. Esophageal injuries should be considered in patients with acute chest symptoms. Recognizing an unsuspected esophageal injury on imaging can be critical to reaching the correct diagnosis given their nonspecific symptomatology. This review article highlights various iatrogenic esophageal injuries and their appearance on computed tomography imaging.
Collapse
|
6
|
Singh D, Zaheer K, Dobariya V, Lester AP, Teka S. The Conundrum of Treating Portal Vein Thrombosis and Submucosal Esophageal Hematoma. Cureus 2020; 12:e12031. [PMID: 33457132 PMCID: PMC7797442 DOI: 10.7759/cureus.12031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Submucosal esophageal hematoma (SEH) is an uncommon clinical entity and a rare form of esophageal insult. Patients usually present with retrosternal chest pain and dysphagia, which often make the diagnosis of SEH difficult as it mimics common cardiovascular and pulmonary disorders. One of the common inciting factors includes the use of anticoagulants. In this report, we discuss the case of a patient with portal vein thrombosis who was treated with heparin and consequently developed SEH.
Collapse
Affiliation(s)
- Davinder Singh
- Internal Medicine, Joan C. Edwards School of Medicine - Marshall University, Huntington, USA
| | - Kamran Zaheer
- Internal Medicine, Joan C. Edwards School of Medicine - Marshall University, Huntington, USA
| | - Varun Dobariya
- Internal Medicine, Joan C. Edwards School of Medicine - Marshall University, Huntington, USA
| | - Alexis P Lester
- Internal Medicine, Joan C. Edwards School of Medicine - Marshall University, Huntington, USA
| | - Samson Teka
- Internal Medicine, Joan C. Edwards School of Medicine - Marshall University, Huntington, USA
| |
Collapse
|
7
|
Sharma B, Lowe D, Antoine M, Shah M, Szyjkowski R. Intramural Esophageal Hematoma Secondary to Food Ingestion. Cureus 2019; 11:e5623. [PMID: 31696016 PMCID: PMC6820886 DOI: 10.7759/cureus.5623] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Intramural esophageal hematoma (IEH) is a rare cause of submucosal esophageal bleeding and it is on the spectrum of esophageal wall injury along with mucosal tears (Mallory-Weiss syndrome) and full thickness perforation (Boerhaave's syndrome). Its risk factors include coagulopathy, trauma (foreign body ingestion or esophageal instrumentation) or it can happen spontaneously. It presents with a triad of chest pain, dysphagia, and hematemesis; however, the triad is only present in 35% of patients. We are presenting a case of IEH secondary to food ingestion that was managed successfully by conservative measures.
Collapse
Affiliation(s)
- Bashar Sharma
- Internal Medicine, State University of New York Upstate Medical University, Syracuse, USA
| | - Dhruv Lowe
- Gastroenterology, State University of New York Upstate Medical University, Syracuse, USA
| | - Marsha Antoine
- Internal Medicine, State University of New York Upstate Medical University, Syracuse, USA
| | - Mili Shah
- Internal Medicine, State University of New York Upstate Medical University, Syracuse, USA
| | - Ronald Szyjkowski
- Gastroenterology, State University of New York Upstate Medical University, Syracuse, USA
| |
Collapse
|
8
|
Takeyama E, Wada A, Amano E, Shibuya H. Oesophageal submucosal hematoma after flow diverter embolization with favourable outcome treated by discontinuing postoperative antiplatelet therapy for only three days: a case report. JA Clin Rep 2019; 5:2. [PMID: 32025915 PMCID: PMC6967279 DOI: 10.1186/s40981-018-0222-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 12/26/2018] [Indexed: 02/02/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Eriko Takeyama
- Department of Anesthesiology, National Hospital Organization Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-Ku, Osaka-city, Osaka, 540-0006, Japan
| | - Aiko Wada
- Department of Anesthesiology and Intensive Care Medicine, Graduate School of Medicine, Osaka University, 2-2, Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Eizo Amano
- Department of Anesthesiology, National Hospital Organization Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-Ku, Osaka-city, Osaka, 540-0006, Japan
| | - Hiromi Shibuya
- Department of Anesthesiology, National Hospital Organization Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-Ku, Osaka-city, Osaka, 540-0006, Japan.
| |
Collapse
|
9
|
Ito S, Iwata S, Kondo I, Iwade M, Ozaki M, Ishikawa T, Kawamata T. Esophageal submucosal hematoma developed after endovascular surgery for unruptured cerebral aneurysm under general anesthesia: a case report. JA Clin Rep 2018; 3:54. [PMID: 29457098 PMCID: PMC5804650 DOI: 10.1186/s40981-017-0124-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 09/26/2017] [Indexed: 12/13/2022] Open
Abstract
Background Esophageal submucosal hematoma is a rare complication after endovascular surgery. We report a case of an esophageal submucosal hematoma which may have been caused by rigorous cough during extubation. Case presentation A 75-year-old woman underwent endovascular treatment for unruptured cerebral aneurysm under general anesthesia. The patient received aspirin and clopidogrel before surgery and heparin during surgery. Activated clotting time was 316 s at the end of surgery. Protamine was not administered and continuous infusion of argatroban was started after surgery. She had a rigorous cough during removal of the tracheal tube and reported retrosternal discomfort postoperatively. She developed hemorrhagic shock after massive hematemesis. A diagnosis of esophageal submucosal hematoma was made by endoscopic examination and computed tomography. Hemostasis was achieved by compression with a Sengstaken-Blakemore tube and endoscopic cauterization. Blood pressure was recovered by blood transfusion. Endoscopic examination performed 7 days after surgery showed that esophageal submucosal hematoma had almost disappeared and slough had adhered to the mucosal laceration. The patient showed good recovery and was discharged 21 days after surgery. Conclusions Careful extubation and postoperative observation are required in patients receiving antiplatelet and anticoagulant therapy.
Collapse
Affiliation(s)
- Sachiko Ito
- 1Department of Anesthesiology, Tokyo Women's Medical University, Tokyo, 162-8666 Japan
| | - Shihoko Iwata
- 1Department of Anesthesiology, Tokyo Women's Medical University, Tokyo, 162-8666 Japan
| | - Izumi Kondo
- 1Department of Anesthesiology, Tokyo Women's Medical University, Tokyo, 162-8666 Japan
| | - Motoyo Iwade
- 1Department of Anesthesiology, Tokyo Women's Medical University, Tokyo, 162-8666 Japan
| | - Makoto Ozaki
- 1Department of Anesthesiology, Tokyo Women's Medical University, Tokyo, 162-8666 Japan
| | - Tatsuya Ishikawa
- 2Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, 162-8666 Japan
| | - Takakazu Kawamata
- 2Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, 162-8666 Japan
| |
Collapse
|
10
|
Roemmele E, Meighan V, Morrissey B. Intramural oesophageal haematoma following traumatic neck injury. BMJ Case Rep 2017; 2017:bcr-2017-222447. [PMID: 29288228 DOI: 10.1136/bcr-2017-222447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
This case describes a previously well 90-year-old woman who presented with neck pain, swelling, dysphagia and hoarseness following a motor vehicle collision. Oesophageal oedema was visualised on CT of cervical spine and subsequent CT angiography highlighted an actively bleeding intramural oesophageal haematoma (IOH) extending from the cervical oesophagus to the carina. This rare phenomenon (IOH) has been described as a possible consequence of blunt trauma to the neck; however, we found no cases resulting from acceleration/deceleration injury. Although this was a potentially life-threatening injury, our patient made a full recovery with conservative management.
Collapse
Affiliation(s)
- Emma Roemmele
- Emergency Department, Sligo University Hospital, Sligo, Ireland
| | | | | |
Collapse
|
11
|
Kumar V, Mallikarjuna HM, Gokulnath. A miniseries of spontaneous intramural esophageal hematoma in hemodialysis patients: a rare cause of dysphagia. Hemodial Int 2014; 18:558-61. [PMID: 24612400 DOI: 10.1111/hdi.12143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Intramural esophageal hematoma (IEH) is an uncommon clinical condition, with a prognosis that is essentially benign. In most cases, a predisposing factor may be seen, with the most common being the history of esophagic instrumentation, food impactions, and thrombocytopenia. We report a miniseries of 3 patients on hemodialysis, who developed IEH. All 3 of them presented with sudden onset and progressively worsening dysphagia and hematemesis. Diagnosis of IEH was established by upper gastrointestinal endoscopy. All patients were managed conservatively, and symptoms of dysphagia and chest pain improved within 6-8 days. Good resolution of hematoma was noted by repeat endoscopy within 2-3 weeks. The reported case of IEH in hemodialysis patients is rare and needs to be identified early when patients present with dysphagia, as anticoagulation during hemodialysis would possibly worsen the clinical condition, the course of which is otherwise benign.
Collapse
Affiliation(s)
- Vinod Kumar
- Department of Nephrology, St. John's Medical College and Hospital, Bangalore, India
| | | | | |
Collapse
|
12
|
Spontaneous esophageal hematoma in a patient with atrial fibrillation. Ann Thorac Surg 2013; 95:1089-91. [PMID: 23438542 DOI: 10.1016/j.athoracsur.2012.07.063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2012] [Revised: 06/27/2012] [Accepted: 07/16/2012] [Indexed: 11/21/2022]
Abstract
We report a case of a spontaneous esophageal hematoma in an anticoagulated patient with atrial fibrillation previously complicated by a cerebrovascular accident. A multidisciplinary discussion resulted in holding of anticoagulation until the esophageal hematoma resolved. The patient was managed nonoperatively and discharged, but returned with a new neurologic deficit 3 weeks later. Aspirin treatment was resumed. After complete resolution of hematoma on outpatient scans, warfarin treatment was restarted. The challenges of managing an esophageal hematoma in a patient requiring anticoagulation are discussed.
Collapse
|
13
|
Jeong ES, Kim MJ, Yoo SH, Kim DH, Jung JS, Koo NH, Chang SH. Intramural hematoma of the esophagus after endoscopic pinch biopsy. Clin Endosc 2012; 45:417-20. [PMID: 23251891 PMCID: PMC3521945 DOI: 10.5946/ce.2012.45.4.417] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Revised: 07/16/2012] [Accepted: 07/16/2012] [Indexed: 12/22/2022] Open
Abstract
Intramural hematoma of the esophagus (IHE) is an uncommon form of esophageal injury, which may be an intermediate of mucosal tear (Mallory-Weiss syndrome) or transmural rupture (Boerhaave's syndrome). To date, the pathogenesis of IHE has not been well documented. IHE may occur within the submucosal layer of the esophagus following dissection of the mucosa. The most commonly presented symptoms are sudden retrosternal pain, dysphagia and hematemesis. The disorder can occur spontaneously or secondarily to trauma. In this report, we present a case of IHE which occurred after endoscopic biopsy and was recovered following conservative management in a patient who was taking long-term aspirin medication.
Collapse
Affiliation(s)
- Eun Soo Jeong
- Division of Gastroenterology, Department of Internal Medicine, KEPCO Medical Center, Seoul, Korea
| | | | | | | | | | | | | |
Collapse
|
14
|
Cha IH, Kim JN, Kwon SO, Kim SY, Oh MK, Ryu SH, Kim YS, Moon JS. [A case of conservatively resolved intramural esophageal dissection combined with pneumomediastinum]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2012; 60:249-52. [PMID: 23089911 DOI: 10.4166/kjg.2012.60.4.249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Intramural esophageal dissection (IED) is a rare form of esophageal injury. We report a rare case of spontaneous IED complicated with pneumomediastinum and successfully improved by conservative management. A 46-year-old man presented to the emergency department with chest pain and hematemesis. The endoscopic diagnosis was suspicious of IED. Chest CT scan performed to rule out complication noted IED combined with pneumomediastinum. He was managed conservatively with nil per oral, intravenous antibiotics and parenteral nutrition. Follow up study after 2 weeks later showed near complete resolution of IED. IED should be included in the differential diagnosis for unexplained acute chest pain, especially, associated with dysphagia and hematemesis. IED with pneumomediastinum or mediastinitis require prompt surgery. So far, there is no case report of IED combined with pneumomediastinum which resolved without surgical treatment. In this case, IED combined with pneumomediastinum has improved by conservative management, so we present a case report.
Collapse
Affiliation(s)
- In Hye Cha
- Division of Gastroenterology, Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | | | | | | | | | | | | | | |
Collapse
|
15
|
Marcos-Pinto R, Caetano C, Ferreira J, Areias J. Spontaneous esophageal hematoma: endoscopic follow up. Dig Endosc 2012; 24:288. [PMID: 22725124 DOI: 10.1111/j.1443-1661.2011.01220.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
|
16
|
Lubel JS, Mahindra P. Spontaneous submucosal esophageal hematoma: a cause of severe thoracic back pain. Clin Gastroenterol Hepatol 2012; 10:A23. [PMID: 22037430 DOI: 10.1016/j.cgh.2011.10.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Revised: 10/04/2011] [Accepted: 10/17/2011] [Indexed: 02/07/2023]
Affiliation(s)
- John Samuel Lubel
- Department of Gastroenterology, Eastern Health, Maroondah and Box Hill Hospital, Melbourne, Australia
| | | |
Collapse
|
17
|
Quintero AM, Gaviria ME, Balparda JK, Cuervo HR. Intramural esophagic hematoma secondary to coumarinic anticoagulation: a case report. CASES JOURNAL 2009; 2:9368. [PMID: 20069068 PMCID: PMC2805651 DOI: 10.1186/1757-1626-2-9368] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Accepted: 12/21/2009] [Indexed: 11/10/2022]
Abstract
Esophagic Intramural Hematoma is an uncommon clinical condition, with a prognosis which is essentially benign. On most cases, a predisposing or precipitating factor may be seen, with the most common ones being the history of esophagic instrumentation, food impactations and thrombocytopenia. In the following manuscript, the authors present the case of a 54-years-old male with history of valve replacement surgery, who was treated at the Clinica Cardiovascular (Medellin, Colombia), with a clinical case of Intramural Esophagic Hematoma that was later confirmed to be due to a Coumarinic overanticoagulation. On this case, it is evidenced that Intramural Esophagic Hematoma is an unrecognized complication of Courmarinic anticoagulation therapy.
Collapse
Affiliation(s)
- Alvaro M Quintero
- Department of cardiology, Clínica Cardiovascular, Medellín, Colombia
| | | | | | | |
Collapse
|
18
|
Shim J, Jang JY, Hwangbo Y, Dong SH, Oh JH, Kim HJ, Kim BH, Chang YW, Chang R. Recurrent massive bleeding due to dissecting intramural hematoma of the esophagus: Treatment with therapeutic angiography. World J Gastroenterol 2009; 15:5232-5. [PMID: 19891027 PMCID: PMC2773907 DOI: 10.3748/wjg.15.5232] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Spontaneous or traumatic intramural bleeding of the esophagus, which is often associated with overlying mucosal dissection, constitutes a rare spectrum of esophageal injury called dissecting intramural hematoma of the esophagus (DIHE). Chest pain, swallowing difficulty, and minor hematemesis are common, which resolve spontaneously in most cases. This case report describes a patient with spontaneous DIHE with recurrent massive bleeding which required critical management and highlights a potential role for therapeutic angiography as an alternative to surgery.
Collapse
|
19
|
Im E, Shim CY, Hwang HJ, Lee SY, Yang WI, Jung YS, Kim HR, Choi EY, Ha JW, Chung N. Transthoracic Echocardiographic Detection, Differential Diagnosis, and Follow-Up of Esophageal Hematoma. Korean Circ J 2007. [DOI: 10.4070/kcj.2007.37.12.666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Eui Im
- Division of Cardiology, Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea
| | - Chi Young Shim
- Division of Cardiology, Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Jin Hwang
- Division of Cardiology, Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea
| | - Seung-Yul Lee
- Division of Cardiology, Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea
| | - Woo-In Yang
- Division of Cardiology, Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon-Suk Jung
- Division of Cardiology, Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea
| | - Hye-Ryun Kim
- Division of Cardiology, Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea
| | - Eui-Young Choi
- Division of Cardiology, Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea
| | - Jong-Won Ha
- Division of Cardiology, Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea
| | - Namsik Chung
- Division of Cardiology, Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
20
|
Cheung J, Müller N, Weiss A. Spontaneous intramural esophageal hematoma: case report and review. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2006; 20:285-6. [PMID: 16609759 PMCID: PMC2659907 DOI: 10.1155/2006/764714] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Intramural esophageal hematoma is a rare form of esophageal injury. The presenting symptoms are nonspecific. Esophagogastroscopy and computed tomography scan are usually needed to establish the diagnosis of intramural esophageal hematoma. Presented here is a patient with spontaneous intramural esophageal hematoma who was successfully treated with conservative measures.
Collapse
Affiliation(s)
- Justin Cheung
- Department of Medicine, Division of Gastroenterology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia
| | - Nestor Müller
- Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia
| | - Alan Weiss
- Department of Medicine, Division of Gastroenterology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia
- Correspondence: Dr Alan Weiss, 903 – 750 West Broadway, Vancouver, British Columbia V5Z 1H8. Telephone 604-879-3992, fax 604-879-3912, e-mail
| |
Collapse
|
21
|
Baudet JS, Alarcón O, Otero S, Moreno M, Sánchez del Río A, Chahim J, Carballo L, Avilés J. [Dissecting hematoma of the esophagus: a rare complication of hemodialysis]. GASTROENTEROLOGIA Y HEPATOLOGIA 2006; 29:111. [PMID: 16448617 DOI: 10.1157/13083911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
22
|
Affiliation(s)
- Hsu-Heng Yen
- Department of Gastroenterology, ChangHua Christian Medical Center, ChangHua, 500 Taiwan, ROC
| | | | | |
Collapse
|
23
|
Salvador Baudet J, Alarcón O, Sánchez del Río A, Alonso JL. [Intramural esophageal hematoma. Clinical and endoscopic evolution]. Med Clin (Barc) 2004; 123:39. [PMID: 15207229 DOI: 10.1016/s0025-7753(04)74404-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
24
|
Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2001; 10:173-88. [PMID: 11499857 DOI: 10.1002/pds.547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
|