Gastric Intramural Hematoma: A Case Report and Literature Review

We present the case of a 47-year-old man that was admitted to the Department of Digestive Diseases due to epigastric abdominal pain, nausea, and vomiting over a three week period. Laboratory tests highlighted the presence of anemia (7 mg/dl) and elevated amylase (153 U/l), lipase (190 U/l), and PCR (100 mg/l). An abdominal ultrasound was performed in which gallstones were observed as well as a destructured pancreas with an adjacent large hyperdense collection. By means of an abdominal computerized tomography scan (CT) the presence of acute pancreatitis with necrosis at the level of the pancreatic head, peripancreatic collections, and a 12 cm hematoma at the level of the gastric wall were noted (Fig. 1). Conservative treatment was established with good clinical evolution. A follow-up CT two months later showed a decrease in the size of the hematoma. DiscussionIntramural hematomas of the gastrointestinal tract are an infrequent pathology. The majority of them occur in the duodenal wall, and a gastric location is less common (1). The most usual etiology is via trauma although it can also be related with endoscopic procedures, ulcer disease, or coagulation disorders (2). Few cases have been described in relation to acute pancreatitis (2-4). In that context it can occur as a result of the irritative effect of pancreatic enzymes on the vascular structures, as well as the compression of pancreatic necrosis and peripancreatic collections over adjacent structures (4).The management of these patients should be conservative in the absence of important active bleeding or other complications. Otherwise, vascular embolization by radiology is a safe and minimally invasive option, reserving surgery for selected cases (1).

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“…Otherwise, vascular embolization by radiology is a safe and minimally invasive option, reserving surgery for selected cases (1 …”

Section: Discussionmentioning

confidence: 99%

Intramural gastric hematoma in the context of an acute pancreatitis

2017

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“…trachea and heart) [6]. Less commonly it can involve the stomach [7], the entire oesophagus [3] or just the lower third of the oesophagus.…”

Section: Discussionmentioning

confidence: 99%

Intramural haematoma of the oesophagus

et al. 2013

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Intramural haematoma of the oesophagus (IHO) is a rare, benign condition presenting as acute chest pain, dysphagia and haematemesis, secondary to a haematoma within the submucosal layer of the oesophagus. Here we present three patients (1 male and 2 female, mean age 68 years). Upper endoscopy, computed tomography (CT) scan and Gastrografin swallow were performed for diagnosis. The patients were managed conservatively. Repeat endoscopy at 1 month revealed complete resolution of the haematoma. A review of literature demonstrates IHO is twice as common in females with mean age of 61.8 years (range 20-92 years). Majority of cases were successfully managed conservatively and discharged on day 8 (range 7-15 days). Only two required surgery. Our experience and review of the literature demonstrate IHO has excellent prognosis with conservative treatment. Misdiagnosis and incorrect treatment as Boerhaave's syndrome, a cardiac event or a pulmonary pathology could lead to worsening of the clinical condition.

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“…[1][2][3][4][5][6] Hematoma can develop in the submucosal layer and the proper muscle layer of the gastrointestinal wall. 8 It can be accompanied by hematemesis, nausea, vomiting, epigastric pain that can simulate acute coronary syndrome.…”

Section: Figurementioning

confidence: 99%

“…2 There is no standard therapy and most cases are managed conservatively with blood transfusion and anticoagulation reversal. 1,[3][4][5][6] In hematoma with substantial bleeding and a trend toward enlargement, transcatheter arterial embolization or surgical therapy (including total gastrectomy) may be indicated. 2,7 Surgery is also a treatment of choice, especially in patients with hematomas which are difficult to distinguish from tumors.…”

Section: Figurementioning

confidence: 99%

“…Most cases of gastrointestinal tract hematomas are located in the esophagus or in the duodenum, being usually associated with anticoagulant therapy, coagulopathy, trauma, ulcer, amyloid angiopathy, repeated vomiting, complications of endoscopy and idiopathic disease. [1][2][3][4][5][6][7] A case of gastric hematoma in a patient using warfarin in a conservative measure will be described in this short report.…”

Section: Introductionmentioning

confidence: 99%

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