Idiopathic Submucosal Hematoma of Esophagus Complicated by Dissecting Aneurysm, Followed-Up Endoscopically During Conservative Treatment

Abstract

Submucosal hematoma of the esophagus is encountered as a rare complication of endoscopic treatment for esophageal varices, but is seen more often with the increasing frequency of endoscopic applications. Idiopathic submucosal hematoma is a rarer event and in most cases sudden intense vomiting has been postulated as its cause. We report here the case of such a patient whose condition was complicated by a dissecting aneurysm. During conservative treatment, careful follow-up was required to differentiate the submucosal hematoma from an aorto-esophageal fistula.

Esophageal submucosal hematoma: a case report and review of the literature

“…The male-to-female ratio was 1 : 1.8 [3]. In Japan, 32 patients, including our patient, with esophageal submucosal hematoma lesions, excluding patients with postsclerotherapy conditions, have been reported (Table 1) [2,8,[11][12][13][14][15][16][17][18][19]. The male-to-female ratio was 1 : 1.5, and the mean age was 55.6 years (32-82 years), which were similar to the values reported by Cullen and McIntyre [3].…”

“…Boerhaave's syndrome causes more fulminant and severe thoracic pain, and often induces septic shock, requiring emergency surgery [6]. Among the three types of acute esophageal injury, esophageal submucosal hematoma, excluding that after sclerotherapy for varices [7], is relatively rare [8,9].…”

Esophageal obstruction due to extensive intramural esophageal dissection: diagnosis and treatment using an endoscopic ‘rendezvous’ technique

“…Intramural esophageal dissection, first described in 1957, has been known by many names including intramural perforation, intramural rupture, esophageal laceration, submucosal hematoma, esophageal apoplexy, and dissecting intramural hematoma of the esophagus. 1,[6][7][8][9][10] In the large majority of cases, the esophageal dissection is caused by an expanding intramural hematoma. Indeed, some authors have contended that all esophageal dissections are due to intramural hematomas.…”

Potential causes and alternate methods for diagnosis and treatment of small colon submucosal haematoma: can we extrapolate from human patients?

“…In human patients, gastrointestinal submucosal haematoma formation is also uncommon. While submucosal haematomas can occur at various regions of the gastrointestinal tract, including the oesophagus (Kise et al 2001;Ganeshram and Harrison 2002), duodenum (Hughes et al 1977), jejunum (Birns et al 1979), sigmoid colon (Yoshida et al 1983) and rectum (TerKonda et al 1992), of 274 cases only 12 involved the colon, with no cases involving the rectum (Hughes et al 1977). Interestingly, the large intestine is thought to be less commonly affected, because the taenia coli play a protective role against initiation and expansion of the haematoma (Abbas et al 2002a,b).…”

“…Interestingly, the large intestine is thought to be less commonly affected, because the taenia coli play a protective role against initiation and expansion of the haematoma (Abbas et al 2002a,b). Common causes of gastrointestinal tract submucosal haematomas in human patients include blunt abdominal trauma, anticoagulant therapy (particularly warfarin toxicity), coagulopathy (for example, idiopathic thrombocytopaenia, haemophilia), pancreatic disease, alcoholism, malignancy (for example, leukaemia, lymphoma, myeloma), inflammatory and immune-mediated disease (for example, vasculitis), chemotherapy and bone transplantation, and in some cases the cause is unknown (Birns et al 1979;Kise et al 2001). Many cases of gastrointestinal submucosal haematoma formation in man occur in the older (over 60 years) population (Ganeshram and Harrisson 2002;Polat et al 2003), probably as a consequence of a higher incidence of underlying disease.…”