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Related Experiment Videos

Atsushi Kanamori1,2, Yuji Nadatani1,2, Nahoko Kushiyama2

  • 1Department of Premier Preventive Medicine/MedCity21 Osaka Metropolitan University Graduate School of Medicine Osaka Japan.

DEN Open
|April 17, 2024
PubMed
Summary

Esophageal submucosal hematoma is a rare complication of endoscopy. This case highlights its occurrence during transnasal endoscopy, emphasizing differential diagnosis for hematemesis.

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Area of Science:

  • Gastroenterology
  • Endoscopy
  • Medical Case Reports

Background:

  • Esophageal submucosal hematoma is a rare complication, typically associated with therapeutic endoscopic procedures.
  • Risk factors for esophageal injury include patient characteristics like thinness, alcohol consumption, and pre-existing conditions such as reflux esophagitis.

Observation:

  • A case report details a 38-year-old woman with a history of reflux esophagitis who developed an esophageal submucosal hematoma during unsedated transnasal endoscopy.
  • The patient presented with hematemesis, initially suspected as Mallory-Weiss syndrome or epistaxis.
  • Sedated endoscopy revealed a submucosal tumor-like lesion and mucosal laceration with blood clots, leading to a dual diagnosis.

Findings:

  • The esophageal submucosal hematoma was diagnosed alongside a potential Mallory-Weiss syndrome.

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  • Conservative management with vonoprazan was initiated, leading to hematoma healing within 28 days.
  • No hemostatic intervention was required due to non-severe bleeding.

    • Implications:

    • This is the first reported instance of esophageal submucosal hematoma occurring during transnasal endoscopy.
    • It underscores the importance of considering esophageal submucosal hematoma and Mallory-Weiss syndrome in the differential diagnosis of hematemesis.
    • Patient factors like severe thinness, alcohol use, and reflux esophagitis may predispose individuals to this complication.