Gastric intramural hematoma subsequent to thoracic aortic dissection: Case report and literature review

Abstract

IntroductionIntramural hematomas of the gastrointestinal tract are uncommom, usually located in the esophagus or duodenum, with idiophatic or secondary causes. We present a very rare case of gastric intramural hematoma caused by an unpublished etiology, with literature review.Case presentationAn elderly woman suffered acute thoracic aorta dissection followed by gastric intramural hematoma, diagnosed through endoscopy and computed tomography angiography. The treatment included endovascular aortic repair and conservative management.DiscussionThe postulated mechanism for the bleeding in gastric intramural hematoma is shredding of terminal arteries at the point of penetration into the muscular layer with subsequent dissection of the muscularis propria from the submucosa. The most frequently cited risk factor is hemorrhagic diathesis/anticoagulant use and the main etiologies are trauma and post-interventional endoscopy. In the diagnosis work-up, computed tomography is the method of choice, usually associated with endoscopy. There is no standard of care for such rare condition. Thus, treatment may be cause-dependent, ranging from conservative to minimally invasive and/or surgery.ConclusionsGastric intramural hematoma is a rare disorder with many causes and we described a new etiology for it. The computed tomography is the diagnostic modality of choice, with the aid of other examinations. The treatment comprises conservative measures, minimally invasive approach or most commonly surgery.

Spontaneous Gastric Intramural Hematoma: Case Report and Literature Review

“…In general, surgical management of GIH is recommended where there is unclear diagnosis, suspected complications, hematoma involving a large part of the gastric wall, ongoing bleeding, failure of minimally invasive therapy, or when one cannot differentiate it from malignant gastric tumors; moreover, the decision to operate emergently and kind of surgery is mainly driven by the clinical scenario [ 9 , 12 ]. In four of the six reported cases of SGIH surgical management was done, and in all of them, the diagnosis of intramural hematoma was post-operation.…”

Spontaneous Gastric Intramural Hematoma Operated Due to Gastrointestinal Stromal Tumor Pre-diagnosis

“…1,2 In the literature, it is seen that the most common etiological condition is trauma. [3][4][5] Hematological diseases such as hemophilia and Von Willebrand disease and long-term anticoagulant use are important risk factors for the development of intramural gastric hematoma. 6 It may also occur less frequently in peptic ulcer disease, chronic pancreatitis, spleen injury, and presence of foreign bodies in the stomach wall.…”

“…In the re- ). 3 The indication for surgical treatment is the patient's clinical findings and hemodynamic status, the size of the lesion, destruction of the stomach wall, and failure to diagnose during the examination period. Subtotal or total gastrectomy is applied depending on the location.…”

A Rare Case of Gastric Intramural Hematoma Secondary to Hemorrhagic Pancreatitis

“…The condition is rare, with the majority of upper gastrointestinal hematomas being localized to the esophagus or duodenum [ 3 ]. A proposed mechanism for the formation of a GIH is the shearing of the terminal arteries within the muscular layer of the gastric wall, leading to hemorrhaging and subsequent separation of the submucosa from the muscularis externa [ 4 ]. The causes of a GIH can be external trauma, iatrogenic injury, intestinal pathology (such as a peptic ulcer disease), anticoagulant therapy, coagulopathies, cancers, parasitic infection, pancreatitis, idiopathic, and others [ 5 ].…”