ABSTRACT
Objective To study the etiology clinical features, treatment outcomes and prevention of esophageal submucosal hematoma caused by endoscopic injection sclerotherapy (EIS) of esophageal varices. Methods We retrospectively reviewed the clinical data of patients who were diagnosed with esophageal submucosal hematoma caused by EIS and treated in our hospital from Jan 2014 to July 2016. Five patients were analyzed including one patient receiving endoscopic gastrointestinal catheterization combined with medication, and the remaining four received medication therapy only. Results All five patients were discharged with clinical improvement. However the patients treated only with medication therapy recovered more slowly than the ones who treated with combined therapy. No treatment related side-effects were observed among two treatment groups. Conclusion Endoscopic gastrointestinal catheterization combined with medication may be an effective treatment for esophageal submocasal hematoma caused by EIS. However, the actual clinical efficacy and safety remain to be proven by future large sample randomized clinical studies.
ABSTRACT
El hematoma esofágico intramural es una entidad infrecuente, con pocos casos registrados en la literatura. Existen factores de riesgo que favorecen la aparición de esta condición como las náuseas y el vómito. Su presentación clínica más frecuente es la tríada de hematemesis, disfagia y dolor torácico. El tratamiento es conservador en la mayoría de los casos. En este trabajo presentamos nuestra experiencia en 7 casos recolectados durante los últimos 8 años, en los cuales se puede apreciar todo el espectro de la enfermedad desde la disección submucosa hasta la perforación del esófago.
Intramural esophageal hematomas are rare with few cases reported in the literature. Risk factors that affect the incidence of this condition include nausea and vomiting, but its most common clinical presentation is the triad of hematemesis, dysphagia and chest pain. Conservative treatment is best in most cases. We present our experience in 7 cases collected during the last 8 years in which you can see the entire spectrum of the disease from submucosal dissection to perforation of the esophagus.
Subject(s)
Humans , Female , Aged , Dissection , Esophageal Perforation , HematomaABSTRACT
Se presenta el caso de un paciente de 67 años de sexo masculino, hipertenso, diabético y usuario de aspirina en dosis anticoagulante, que consulta en el servicio de urgencia por un cuadro de inicio súbito de dolor retroesternal asociado a disnea severa y estridor. La evaluación mediante nasofibroscopfa muestra una gran masa supraglótica que obstruye el 80 por ciento del lumen, compatible con una masa esofágica. La tomograffa computarizada de tórax muestra una imagen compatible con un hematoma disecante esofágico de gran extensión, desde laringe hasta la unión gastroesofágica. El paciente se maneja en forma conservadora mediante observación, analgesia y alimentación párenteral. Se evalúa en forma periódica con tomograffa computarizada y nasofibroscopfa. Evoluciona con reabsorción progresiva del hematoma y disminución del compromiso laríngeo por lo que es dado de alta a los 10 días. Este caso ejemplifica una rara patología que además tiene una forma atípica de presentación, con obstrucción laríngea.
We present a case of a 67 years old hipertense and diabetic male. The patient refered a sudden onset of chest pain associated with severe dysnea and audible stridor. Nasofibroscopy showed a supraglottic mass that obstructed an estimated 80 percent of normal lumen, suggestive of an esophageal mass. Thorax CT scan revealed an ¡mage of a dissecting esophageal haematoma that compromised most of the esophageal extension, beggining at the laryngeal plane. The patient was managed by conservative means, through observation, analgesia and parenteral nutrition. Close follow up, by CT Scan as well as nasofibroscopy. The patient evolved well, with haematoma reabsorption and decrease of laryngeal obstruction being discharged after 10 days of hospitalization. We report a rare entity that presented in an unusual way.
Subject(s)
Humans , Male , Aged , Esophageal Diseases/surgery , Esophageal Diseases , Hematoma/surgery , Hematoma , Diagnosis, Differential , Esophageal Diseases/etiology , Hematoma/etiology , Laryngoscopy/methods , Tomography, X-Ray ComputedABSTRACT
Endoscopic variceal ligation(EVL) is an accepted alternatives to endoscopic injection sclero- therapy(EIS) in many patients with bleeding esophageal varices. Esophageal hematoma is rare and an unusual complication after EVL or EIS. We present a patient with liver cirrhosis who developed an obstructive esophageal hematoma after EVL.