Intramural gastric hematoma in the context of an acute pancreatitis

Abstract

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).

Intramural Gastric Hematoma after Acute Necrotizing Pancreatitis: A Case Report and Review of Imaging Findings

“…Other possible causes include aneurysm, peptic ulcer disease, and spontaneous occurrence. To the best of our knowledge, 2 IGH cases related to pancreatitis have been reported (3,4). Compared with these 2 studies, the IGH in our case was relatively huge (maximal diameter, 26 cm).…”

“…Pancreatitis-induced intramural gastric hematoma (IGH) is far more seldom reported. Two cases of pancreatitis-related IGH are currently report-Intramural Gastric Hematoma ed in the literature (3,4). Here, we report a rare case of a giant IGH occurring as a delayed complication of pancreatitis, which was diagnosed with computed tomography (CT) and endoscopic ultrasonography (EUS).…”

“…Most of such cases are due to blunt abdominal trauma, including endoscopic procedure complications, ulcer disease, and coagulation disorders (1,2). Intramural hematoma of the gastrointestinal tract related to pancreatitis is rarely reported, and it is most frequently reported in the duodenum (3). Pancreatitis-induced intramural gastric hematoma (IGH) is far more seldom reported.…”

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

“…The endoscopy-related cases include post-percutaneous endoscopic gastrostomy (PEG), argon plasma coagulation (APC), endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), EUS-guided fine needle aspiration (EUS-FNA) and post-injection therapy [ 6 , 7 , [14] , [15] , [16] , [17] , [18] , [19] ]. Furthermore, there are few reports with anedoctal causes for GIH, such as foreign body, peptic ulcer disease, amyloidosis and pancreatitis [ [20] , [21] , [22] , [23] , [24] ]. The authors did not find any previous reports like the present, with aortic dissection-associated GIH.…”

“…There are two documented cases of post-acute pancreatitis GIHs. One was treated conservatively and the other resorted to CT-guided percutaneous drainage successfully [ 23 , 24 ].…”