Submucosal esophageal hematoma precipitated by chronic idiopathic thrombocytopenic purpura

Abstract

Submucosal esophageal hematoma is an uncommon clinical entity. It can occur spontaneously or secondary to trauma, toxins, medical intervention, and in this case, coagulopathy. Management of SEH is supportive and aimed at its underlying cause. This article reports an 81-year-old male patient with chronic idiopathic thrombocytopenic purpura and hypertension that develops a submucosal esophageal hematoma.

Submucosal hematoma with a wide range of lesions, severe condition and atypical clinical symptoms: A case report

“…Characteristic clinical manifestations of SH comprises dysphagia or odynophagia, acute chest pain, and hematemesis[ 3 ]. Typical cases of SH have been reported by several authors[ 1 , 2 , 4 ]. However, no cases of the SH extending from the hypopharynx to the lower esophagus caused by oral administration of hirudin and panax notoginseng powder have been reported, especially cases with atypical clinical manifestations.…”

“…Detailed and accurate acquisition of clinical data of patients, comprehensive physical examination combined with endoscopy, and CT are useful for accurate diagnosis. Risk factors for SH include female sex, hypertension, increased esophageal pressure, coagulopathy, and use of an anticoagulant[ 2 , 4 ]. It has been reported that elderly patients who are taking anticoagulant or antiplatelet medication are at higher risk for SH[ 4 ].…”

“…Submucosal hematoma (SH) of the digestive tract is an uncommon clinical condition, which can occur spontaneously or be caused by trauma such as during endoscopic surgery[ 1 , 2 ]. Characteristic clinical manifestations of SH comprises dysphagia or odynophagia, acute chest pain, and hematemesis[ 3 ].…”

A close call: intramural oesophageal haematoma presenting with airway compromise

“…Aetiology is either iatrogenic, following oesophageal instrumentation for endoscopy, nasogastric tube placement or endotracheal intubation; traumatic, due to foreign body or food bolus, forceful vomiting or dry retching; or spontaneous 2–5 . Anticoagulation, coagulopathy, female sex and advanced age are considered to be the main risk factors 6 …”

“…[2][3][4][5] Anticoagulation, coagulopathy, female sex and advanced age are considered to be the main risk factors. 6 Presentation of IOH can vary depending on the severity of bleeding, degree of oesophageal occlusion and underlying comorbidities. Triad of retrosternal chest pain, dysphagia and haematemesis can be present in up to 35% of patients, with 80% demonstrating two of the three signs.…”