[A submucosal hematoma of the esophagus. A clinical case]

Spontaneous intramural hematoma of the esophagus (SIHE) is a rare condition usually affecting middle-aged or elderly women. It presents as acute substernal or epigastric pain, typically accompanied by dysphagia or hematemesis. SIHE is not usually associated with vomiting, and is therefore clearly distinguishable from hematogenic esophageal disorders, such as the Mallory Weiss lesion and the Boerhaave syndrome. The pathogenesis is in dispute. We present a case of SIHE without a discernible mucosal breach, suggesting a primary intramural bleed as the initiating event. Its diagnosis relies on the history and a barium swallow. Instrumentation can result in further damage to the esophagus. Treatment is conservative and results in resolution of the hematoma and return to normal swallowing. A favorable prognosis is the rule.