An Extremely Rare Association of Alcohol-Induced, Necrotizing, Acute Pancreatitis and Giant Dissecting Hematoma of the Gastric Wall with Hemorrhagic Shock: a Case Report

Abstract

Intramural gastric-wall hemorrhage is an extremely rare condition associated with acute pancreatitis. To the authors’ knowledge, at present, only four cases have been reported in the international literature, the case reported herein being the fifth. We performed an extensive literature review on the issue and compared our data with those of similar reports. A 69-year-old man was admitted to the emergency department complaining of severe epigastric pain with tenderness and muscle guarding. After initial diagnostic workup, acute pancreatitis associated with intramural gastric mass was diagnosed. Upfront conservative treatment was begun, but the patient worsened, with class 3 hemorrhagic shock appearing. The patient underwent emergent explorative laparotomy that revealed a huge intraparietal gastric hematoma requiring total gastrectomy to control bleeding. Because an intramural gastric-wall hematoma is a very rare condition and usually associated with both primary and acquired coagulation disorders, it requires a high suspicion index for a prompt diagnosis. Small gastric-wall hematomas can be treated conservatively, especially when associated with anticoagulation therapy, but surgery must always be considered for patients who fail conservative or angiographic treatment. Furthermore, surgery may be considered an upfront therapy for emergent cases. Surgery remains the procedure of choice in all cases not responding to conservative therapy and when hemorrhagic shock develops.