Intramural Hematoma Of Esophagus Research Articles

A miniseries of spontaneous intramural esophageal hematoma in hemodialysis patients: A rare cause of dysphagia

Intramural esophageal hematoma (IEH) is an uncommon clinical condition, with a prognosis that is essentially benign. In most cases, a predisposing factor may be seen, with the most common being the history of esophagic instrumentation, food impactions, and thrombocytopenia. We report a miniseries of 3 patients on hemodialysis, who developed IEH. All 3 of them presented with sudden onset and progressively worsening dysphagia and hematemesis. Diagnosis of IEH was established by upper gastrointestinal endoscopy. All patients were managed conservatively, and symptoms of dysphagia and chest pain improved within 6-8 days. Good resolution of hematoma was noted by repeat endoscopy within 2-3 weeks. The reported case of IEH in hemodialysis patients is rare and needs to be identified early when patients present with dysphagia, as anticoagulation during hemodialysis would possibly worsen the clinical condition, the course of which is otherwise benign.

Dissecting intramural hematoma of esophagus after thrombolytic therapy: A case report

Esophageal hematoma is a relatively rare event. We report a case of severe chest pain associated with myocardial infarction and recurrent chest pain after administration of a thrombolytic agent. The chest pain was different from the presenting symptom and accompanied by 2 episodes of hematemesis. Esophageal hematoma was confirmed after endoscopy and computed tomography. Esophageal hematoma is a relatively rare event after thrombolytic therapy.

Spontaneous intramural esophageal hematoma (IEH) secondary to anticoagulation and/or thrombolysis therapy in the setting of a pulmonary embolism: a case report

Intramural esophageal hematoma is part of a spectrum of esophageal injuries. Vomiting and straining, endoscopic procedures and bleeding disorders are the most common predisposing factors. However, it can also be an unusual complication of anticoagulation and/or thrombolysis therapy. The most common symptoms are retrosternal chest pain, dysphagia and hematemesis. Computed tomography is the modality of choice and treatment is medically conservative with the cessation of Warfarin and thrombolysis use. When anticoagulation and/or thrombolysis therapy is necessary, periodic reassessment for symptoms of intramural esophageal hematoma may be helpful for early identification and management. We described one case of intramural esophageal hematoma possibly resulting from anticoagulation and/or thrombolysis therapy in the setting of pulmonary embolism.

A Rare Cause for Acute Chest Pain in the Emergency Setting That Is Hard to Swallow

Intramural esophageal hematoma is a very rare but important cause of chest pain. This condition shares similarity with the diagnosis of other thoracic emergencies and has a high potential for misdiagnosis. The emergency clinician plays a critical role in the early identification and management of these patients. The management of intramural hematomas is typically conservative, and a misdiagnosis could lead to deleterious effects. Preexisting coagulopathy is one of the major risk factors. With the advent of new anticoagulation medications to prevent thromboembolic events, it is important that emergency medicine providers expand the differential diagnosis of chest pain.

Emesis-Induced Intramural Esophageal Hematoma in a Woman on Anti-Platelet Therapy

Emesis-Induced Intramural Esophageal Hematoma in a Woman on Anti-Platelet Therapy

A rare cause of haematemesis and chest pain

This article discusses an elderly woman presenting with haematemesis and chest pain who underwent urgent oesophago-gastroduodenoscopy. This revealed a large dissecting intramural oesophageal haematoma, initially mistaken for a varix. This is a rare cause of haematemesis and chest pain but has characteristic endoscopic findings. It is a benign condition that may be managed conservatively and both clinicians and endoscopists should be aware of its classical presentation. Misdiagnosis of the chest pain as cardiac ischaemia may have an adverse outcome if antiplatelet or anticoagulation therapy is commenced. Follow up endoscopy a week later showed complete resolution of the lesion leaving a linear mucosal defect.

Spontaneous Intramural Esophageal Hematoma in Association With Idiopathic Thrombocytopenic Purpura: A Cause of Non-Cardiac Chest Pain

An 81-year-old man presented to the Emergency Department with severe acute onset epigastric and retrosternal chest discomfort with dysphagia coincident with the consumption of a small meal. His medical history was notable for chronic idiopathic thrombocytopenic purpura (ITP) as well as a remote history of a prior cardiac arrest with pacemaker/defibrillator implantation. There was no significant premorbid history of upper gastrointestinal or general constitutional symptomatology. Physical examination was unremarkable aside from audible heart sounds in the epigastrum and moderate epigastric tenderness to palpation.

Intramural esophageal hematoma after elective injection sclerotherapy

Although endoscopic esophageal variceal sclerotherapy has been largely supplanted by variceal band ligation, it is still performed routinely in many institutions, especially in developing countries. Intramural esophageal hematoma has been described as a rare complication of sclerotherapy. Risk factors have not been completely established. To demonstrate the incidence of post-sclerotherapy intramural esophageal hematoma in our hospital and discuss the possible factors involved. This is a retrospective observational study made at the 'Hospital Universitário Clementino Fraga Filho', Rio de Janeiro, RJ, Brazil, reviewing the medical records of all esophageal variceal sclerotherapy procedures performed from April 2000 to November 2005. The evaluation of the clinical, laboratorial and endoscopic features in our patients and those reported in the literature was also done. Review of literature was performed through MEDLINE search. A total of 1,433 esophageal variceal sclerotherapy procedures were performed in 397 patients, with an intramural esophageal hematoma incidence of 4 cases (0.28%). Three of our patients developed additional complications, and one death was a direct consequence of a rupture of the hematoma. Nineteen well described cases were reported in the literature. Intramural esophageal hematoma occurred mostly after the forth esophageal variceal sclerotherapy session. Coagulation disturbances were present in the majority of cases. Intramural esophageal hematoma is a rare complication of esophageal variceal sclerotherapy and its incidence in our institution was similar to those observed in the literature. Our study suggests that this complication occurs as a result of a fragile esophageal mucosa after previous esophageal variceal sclerotherapy sessions. Impaired coagulation, although not essential, could contribute to hematoma formation and extension through esophageal submucosa.

Dysphagia soon after off-pump coronary surgery: the single suture technique

We report a case of a 76-year-old man complaining of dysphagia for solid food associated with a weight loss following an off-pump double vessel coronary artery revascularization. Multislice spiral computed tomography showed a 6 cm x 2.5 cm solid formation next to the posterior wall of the left atrium, adjacent to the pericardium and the right anterolateral side of the esophagus. The mass was confirmed to be an intramural esophageal hematoma by endoscopic ultrasound-guided fine-needle aspiration cytology. Injury to esophagus during the placement of deep pericardial sutures and postoperative infusion of heparin are claimed to be causes of this complication.

腹腔鏡下胆嚢摘出後に発症した特発性食道粘膜下血腫の１例

腹腔鏡下胆嚢摘出後に発症した特発性食道粘膜下血腫の１例

Spontaneous Intramural Esophageal Hematoma: Case Report and Review

Intramural esophageal hematoma is a rare form of esophageal injury. The presenting symptoms are nonspecific. Esophagogastroscopy and computed tomography scan are usually needed to establish the diagnosis of intramural esophageal hematoma. Presented here is a patient with spontaneous intramural esophageal hematoma who was successfully treated with conservative measures.

Transient esophageal obstruction in a young man: an intramural esophageal hematoma?

SUMMARY. We present a case of a 20-year-old, previously healthy, male student who presented with dysphagia secondary to mechanical esophageal obstruction that resolved spontaneously. Although our patient did not have 'classic' patient characteristics, we believe that the clinical evidence supports the conclusion that our patient was an atypical presentation of intramural esophageal hematoma.

Spontaneous intramural esophageal hematoma

We report the case of an 80-year-old woman who developed a spontaneous intramural esophageal hematoma and review the available literature. Spontaneous intramural esophageal hematoma (SIOH) is a rare but important condition. Because the cardinal symptom is severe chest pain, the condition is often initially misdiagnosed as an acute cardiac event or aortic dissection. Increased awareness of SIOH may prevent misdiagnosis on the basis of endoscopic and radiological appearances.

Spontaneous intramural esophageal hematoma

Spontaneous intramural esophageal hematoma is a rare cause of chest pain. Erroneous diagnosis may cause inappropriate management and disaster. We describe one case of spontaneous intramural hematoma that was successfully managed by conservative treatment. Endoscopic and radiographic images are reviewed. The benefit of endoscopic ultrasound is emphasized.

Intramural esophageal hematoma after endoscopic injection sclerotherapy for bleeding varices

Endoscopic variceal sclerotherapy (EVS) is widely used to treat bleeding esophageal varices. A variety of complications have been reported after EVS, including intramural hematoma of the esophagus (IHO), which occurs infrequently. The present report describes four new cases of IHO after EVS and reviews the pathogenesis, diagnosis and treatment of the condition. In addition, 10 patients with IHO after EVS documented in the literature are analyzed. Between 1984 and 2001, 580 patients with bleeding esophageal varices had 5038 endoscopies and underwent a total of 2628 variceal injection sessions. The incidence, presentation and response to conservative management of IHO were evaluated. Four of the 580 patients (0.7%) developed IHO as a complication of EVS. All developed severe retrosternal chest pain, sudden‐onset dysphagia and odynophagia after EVS. Diagnosis was confirmed using upper gastrointestinal contrast studies. Patients were kept nil per mouth and received intravenous fluids until able to swallow without difficulty. Symptoms usually began to resolve spontaneously within 36–72 h and disappeared completely in 2–3 weeks. In a patient who has recently had EVS and has a clinical picture compatible with the diagnosis of IHO, contrast studies provide the simplest way of confirming the diagnosis and excluding an esophageal perforation. Treatment of IHO after endoscopic variceal sclerotherapy should be conservative, due to the benign, self‐limiting nature of this uncommon complication.

Extensive spontaneous submucosal dissection of the esophagus: Long-term sequential endoscopic observation and treatment

Esophageal submucosal dissection is the most rarely reported of the 3 types of acute esophageal injury, which include the Mallory-Weiss and Boerhaave's syndromes. Although its etiology is controversial, the treatment and prognosis for esophageal submucosal dissection are the same as for the Mallory-Weiss syndrome. 1 Steadman C Kerlin P Crimmins F Bell J Robinson D Dorrington L et al. Spontaneous intramural rupture of the oesophagus. Gut. 1990; 31: 845-849 Crossref PubMed Scopus (62) Google Scholar , 2 Ho CL Young TH Yu CY Chao YC Intramural hematoma of the esophagus: ED diagnosis and treatment. Am J Emerg Med. 1997; 15: 322-323 Abstract Full Text PDF PubMed Scopus (13) Google Scholar , 3 Mion F Bernard G Valette PJ Lambert R Spontaneous intramural hematoma of esophagus. Gastrointest Endosc. 1978; 24: 172-174 Abstract Full Text PDF PubMed Scopus (28) Google Scholar , 4 Walts HD Postemetic hematoma: a varient of the Mallory-Weiss syndrome. Am J Surg. 1976; 132: 320-321 Abstract Full Text PDF PubMed Scopus (17) Google Scholar Conservative management is usually successful and prognosis is excellent. However, treatment appears to depend on the extent of submucosal dissection, and close follow-up is needed in cases requiring prolonged periods of time for complete healing. Serial endoscopic findings and clinical data on the course of esophageal submucosal dissection have not been reported. This is a description of the sequential endoscopic findings, sequelae, and treatment of a patient with extensive esophageal submucosal dissection.

Mechanical Tracheal Obstruction Due to an Intramural Esophageal Hematoma following Endoscopic Variceal Sclerotherapy

Endoscopic injection sclerotherapy is widely used as treatment for bleeding esophageal varices. Esophageal intramural hematoma is a rare complication following endoscopic injection sclerotherapy. Patients present with pain and dysphagia due to esophageal obstruction. We present the first reported case of respiratory failure resulting from an intramural hematoma causing posterior tracheobronchial compression. Although patients with alcoholic cirrhosis and bleeding varices requiring respiratory support generally have a poor prognosis this may be an occasion when ventilatory support may be expected to be easily withdrawn after hematoma resolution.

A case of intramural esophageal hematoma: complication of anticoagulation with heparin

Intramural esophageal hematoma has also been referred to as esophageal apoplexy. It is thought to be usually due to esophageal injury as, for example, in association with the Mallory-Weiss (MW) and Boerhaave syndromes. 1 Hess U Brucher BL Cavallaro A Hannig C Stein HJ Ott R Intramural esophageal hematoma after cardioversion. Dis Esophagus. 1997; 10: 225-228 PubMed Google Scholar , 2 Folan RD Smith RE Head JM Esophageal hematoma and tear requiring emergency surgical intervention. A case report and literature review. Dig Dis Sci. 1992; 37: 1918-1921 Crossref PubMed Scopus (32) Google Scholar There are 13 reports of esophageal hematoma in patients undergoing anti-coagulation therapy, but only two related to heparin administration. 3 Cullen SN Chapman RW Dissecting intramural haematoma of the oesophagus exacerbated by heparin therapy. QJM. 1999; 92: 123-124 Crossref PubMed Google Scholar , 4 Boyere L Pezet D Boissier A Naamee A Michel JL Escande G Intramural hematoma of the esophagus. Value of magnetic resonance imaging. Gastroenterol Clin Biol. 1992; 16: 482-483 PubMed Google Scholar This is a case of intramural esophageal hematoma thought to be caused by retching while under therapy with heparin sodium.

Intramural esophageal hematoma: A diagnostic dilemma

Intramural esophageal hematoma (IEH) is an uncommon cause of acute chest pain. More than 60% of patients with IEH have an underlying etiology or predisposing factor, most commonly esophageal instrumentation,1-4 vomiting,5,6 trauma,4,7 pill-induced injury,8 food impaction related9 and coagulation defects.10 When a predisposing factor such as vomiting or instrumentation is present, the diagnosis can often be made without delay because the patient typically complains of chest pain immediately after the therapeutic endoscopic procedure or excessive vomiting.

Spontaneous rupture of iatrogenic intramural hematoma of esophagus during endoscopic sclerotherapy

Endoscopic injection sclerotherapy (EIS) is commonly used in the management of acute variceal bleeding and prevention of variceal bleeding.1,2 Many complications of EIS have been described.3,4 We herein describe a patient who developed an intramural hematoma immediately after undergoing EIS for prevention of variceal bleeding. This report focuses on the sequential endoscopic findings and the spontaneous rupture of the hematoma within a few minutes after sclerotherapy.