Spontaneous Intramural Hematoma of the Esophagus

Ko, Bong Min; Park, Gyu Ho; Hong, Su Jin; Kim, Jin Oh; Cho, Joo Young; Lee, Jun Seong; Lee, Moon Sung; Shim, Chan Sup

Abstract

Spontaneous intramural hematoma of the esophagus is a rare condition in which an intramural hemorrhage leads to a varying degree of submucosal dissection of the esophageal wall. This disorder has been seen predominantly in women in the sixth or seventh decade and has occured with variable etiology. The pathogenesis of this disorder has yet to be clarified. The triad of symptoms of this disorder includes retrostemal pain, mild hematemesis and odynophagia. The diagnosis is usually made by endoscnpy or with an esophagogram, It is important to differentiate esophageal submucosal dissection from other disorders of similar appearance, such as Mallory-Weiss syndrome, esophageal perforation, or dissecting aneurysm, all of which require surgical treatment. The prognosis of spontaneous intramural hematoma of the esophagus (SIHE) is excellent with conservative therapy, but close follow-up care is necessary. A 62-year-old female was admitted to our hospital complaining of chest pain and hematemesis. Endoscopic features showed a large bluish hematoma which obliterated esophageal lumen from the proximal esophagus. We report a case of spontaneous intramural hematoma of the esophagus showing typical endoscopic findings with spontaneous improvement with a review of the literature.