Clin Endosc.  2012 Nov;45(4):417-420.

Intramural Hematoma of the Esophagus after Endoscopic Pinch Biopsy

• Jeong ES
• Kim MJ
• Yoo SH
• Kim DH
• Jung JS
• Koo NH
• Chang SH

Abstract

Intramural hematoma of the esophagus (IHE) is an uncommon form of esophageal injury, which may be an intermediate of mucosal tear (Mallory-Weiss syndrome) or transmural rupture (Boerhaave's syndrome). To date, the pathogenesis of IHE has not been well documented. IHE may occur within the submucosal layer of the esophagus following dissection of the mucosa. The most commonly presented symptoms are sudden retrosternal pain, dysphagia and hematemesis. The disorder can occur spontaneously or secondarily to trauma. In this report, we present a case of IHE which occurred after endoscopic biopsy and was recovered following conservative management in a patient who was taking long-term aspirin medication.

Keyword

Esophagus; Intramural hematoma; Endoscopic biopsy; Aspirin

MeSH Terms

Aspirin
Biopsy
Deglutition Disorders
Esophagus
Hematemesis
Hematoma
Humans
Mucous Membrane
Rupture
Aspirin

Figure

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  Fig. 1 Endoscopic findings. (A) Black colored spot pigmentation and mucosal denudation was noted at the incision 32 cm of the esophagus. (B) A bluish swollen lesion was observed through pinch biopsy. (C) Soft bluish submucosal lesion was markedly spread along the posterior wall of the esophagus. (D) A 3 to 4 cm linear submucosal ulceration in the absence of active hemorrhage was noted on the lower esophagus.

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  Fig. 2 Chest computed tomography (CT) images on admission. (A) Transverse view of contrast enhanced CT showed a non-enhancing mass involving the posterior wall of the esophagus. (B) Coronal view of contrast enhanced CT showed an elongated non-enhancing mass involving the entire esophagus.

Reference

1. Hiller N, Zagal I, Hadas-Halpern I. Spontaneous intramural hematoma of the esophagus. Am J Gastroenterol. 1999; 94:2282–2284. PMID: 10445563.

2. Yen HH, Soon MS, Chen YY. Esophageal intramural hematoma: an unusual complication of endoscopic biopsy. Gastrointest Endosc. 2005; 62:161–163. PMID: 15990842.

3. Wang AY, Riordan RD, Yang N, Hiew CY. Intramural haematoma of the oesophagus presenting as an unusual complication of endotracheal intubation. Australas Radiol. 2007; 51(Suppl):B260–B264. PMID: 17991080.

4. Kerr WF. Spontaneous intramural rupture and intramural haematoma of the oesophagus. Thorax. 1980; 35:890–897. PMID: 6973833.

5. Morritt GN, Walbaum PR. Spontaneous dissection of the oesophagus. Thorax. 1980; 35:898–900. PMID: 7268663.

6. Hsu MT, Lin XZ, Chang TT, Shin JS, Chen CY, Sheu BS. Sequential endoscopic findings in spontaneous intramural hematoma of the esophagus. Endoscopy. 1996; 28:465. PMID: 8858244.

7. Borrie J, Sheat J. Spontaneous intramural oesophageal perforation. Thorax. 1970; 25:294–300. PMID: 5452282.

8. Hanson JM, Neilson D, Pettit SH. Intramural oesophageal dissection. Thorax. 1991; 46:524–527. PMID: 1877040.

9. Smith G, Brunnen PL, Gillanders LA, Teo HS. Oesophageal apoplexy. Lancet. 1974; 1:390–392. PMID: 4131036.

10. Yamashita K, Okuda H, Fukushima H, Arimura Y, Endo T, Imai K. A case of intramural esophageal hematoma: complication of anticoagulation with heparin. Gastrointest Endosc. 2000; 52:559–561. PMID: 11023585.

11. Lauzon SC, Heitmiller RF. Transient esophageal obstruction in a young man: an intramural esophageal hematoma? Dis Esophagus. 2005; 18:127–129. PMID: 16053490.

12. Cho CM, Ha SS, Tak WY, et al. Endoscopic incision of a septum in a case of spontaneous intramural dissection of the esophagus. J Clin Gastroenterol. 2002; 35:387–390. PMID: 12394226.

13. Adachi T, Togashi H, Watanabe H, et al. Endoscopic incision for esophageal intramural hematoma after injection sclerotherapy: case report. Gastrointest Endosc. 2003; 58:466–468. PMID: 14528234.

14. Heceta WG, Wruble LD, Pate JW. Esophageal obstruction due to intermuscular hematoma following pneumatic dilatation. Chest. 1976; 69:115–117. PMID: 1244267.

15. Klygis LM. Esophageal hematoma and tear from a taco shell impaction. Gastrointest Endosc. 1992; 38:100. PMID: 1612365.

16. Piccione PR, Winkler WP, Baer JW, Kotler DP. Pill-induced intramural esophageal hematoma. JAMA. 1987; 257:929. PMID: 3806873.

17. Ashman FC, Hill MC, Saba GP, Diaconis JN. Esophageal hematoma associated with thrombocytopenia. Gastrointest Radiol. 1978; 3:115–118. PMID: 307510.

18. Yang JN, Lim YJ, Kang JH, et al. Intramural hematoma of the esophagus after endoscopic pinch biopsy and endoscopic band ligation. Korean J Gastrointest Endosc. 2010; 40:107–110.

19. 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. PMID: 1473441.

20. Sudhamshu KC, Kouzu T, Matsutani S, Hishikawa E, Saisho H. Early endoscopic treatment of intramural hematoma of the esophagus. Gastrointest Endosc. 2003; 58:297–301. PMID: 12872110.