Endoscopic appearance of esophageal hematomas.

Abstract

Esophageal hematomas develop from the dissection of the mucosa from the mu scular layers of the esophageal wall and represent an uncommon condition affecting all ages[1-3]. Although the most common cause of esophageal hematomas is iatrogenic mechanical injury-induced by prolonged nasogastric intubation, difficult or forceful endoscopic intubation, or the result of variceal injection sclerotherapy-some may be spontaneous, particularly in patients receiving anticoagulants[3-6]. Presenting symptoms most commonly include dysphagia, hematemesis, and sub-sternal or epigastric pain[5,9]. In this report, we present four cases of esophageal hematomas diagnosed endoscopically, describe their clinical and endoscopic characteristics and propose a classification. As our cases exemplify, therapy is conservative and a favorable prognosis is the rule. Although the diagnosis has traditionally been made by barium esophagography[1] or CAT scanning[1,10], the increased use of endoscopy will allow increased recognition of esophageal hematomas even at a subclinical (asymptomatic) stage and ultimately lead to a better understanding of their etiopathogenesis and their prevention.