Bruising of the esophagus as a cause of gastrointestinal bleeding in a case of heatstroke

Abstract

Alterations in blood clotting are a frequent complication of serious heatstroke and may result in gastrointestinal bleeding. We report the case of a 26-year-old man who was admitted to our hospital with symptoms of hyperthermia associated with encephalopathy and disseminated intravascular coagulation (DIC) after prolonged exposure to sunlight. He presented hematemesis, after which he was diagnosed with having a bruising of the esophagus that took up the upper and lower thirds, there being no other lesions in the stomach or duodenum. After supportive treatment and following the resolution of the underlying pathology, the endoscopy-revealed injuries healed with a complete normalization of the esophageal mucosa. Esophageal submucosal bruising is an exceptional cause of hematemesis in serious heatstroke not previously described in the literature.

Expert consensus on the diagnosis and treatment of heat stroke in China

“…In the acute phase of HS, high fever, reduced blood volume and gastrointestinal ischemia (diversion of gastrointestinal blood to the skin and muscle), oxidative stress and DIC may lead to gastrointestinal mucosal ischemia, intestinal wall edema, intestinal effusion and even bleeding [32,33]. Gastrointestinal dysfunction can occur within 72 h of HS onset, presenting as nausea, vomiting, abdominal pain, diarrhea, and drainage-like stool, and patients with severe HS may have gastrointestinal hemorrhage, perforation and peritonitis [34,35].…”