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Uncommon cause of upper gastrointestinal bleeding: Spontaneous large gastric intramural hematoma
Causa infrecuente de hemorragia digestiva alta: gran hematoma intramural gástrico espontáneo
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Neoplasia de origen en la mucosa profunda, bien delimitada (corchete rojo), cubierta por mucosa foveolar normal y rodeada de mucosa oxíntica conservada (corchete verde).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Mariana Tavecchia Castro, Joaquin Fisac Vázquez, Laura Guerra Pastrián, Aurora Burgos García" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Mariana" "apellidos" => "Tavecchia Castro" ] 1 => array:2 [ "nombre" => "Joaquin" "apellidos" => "Fisac Vázquez" ] 2 => array:2 [ "nombre" => "Laura" "apellidos" => "Guerra Pastrián" ] 3 => array:2 [ "nombre" => "Aurora" "apellidos" => "Burgos García" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210570524002590?idApp=UINPBA00004N" "url" => "/02105705/unassign/S0210570524002590/v1_202410061028/es/main.assets" ] "itemAnterior" => array:17 [ "pii" => "S0210570520302533" "issn" => "02105705" "doi" => "10.1016/j.gastrohep.2020.05.020" "estado" => "S200" "fechaPublicacion" => "2020-09-04" "aid" => "1593" "copyright" => "Elsevier España, S.L.U." 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"apellidos" => "Wu" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210570520302533?idApp=UINPBA00004N" "url" => "/02105705/unassign/S0210570520302533/v2_202101310608/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Image of the month</span>" "titulo" => "Uncommon cause of upper gastrointestinal bleeding: Spontaneous large gastric intramural hematoma" "tieneTextoCompleto" => true "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Tiago Lima Capela, Tiago Cúrdia Gonçalves, Joana Magalhães, José Cotter" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Tiago" "apellidos" => "Lima Capela" "email" => array:1 [ 0 => "tiagolimacapela@gmail.com" ] "referencia" => array:4 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 3 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Tiago" "apellidos" => "Cúrdia Gonçalves" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 2 => array:3 [ "nombre" => "Joana" "apellidos" => "Magalhães" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "José" "apellidos" => "Cotter" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Gastroenterology Department, Unidade Local de Saúde do Alto Ave, Guimarães, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga/Guimarães, Braga, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Braga, Portugal" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Causa infrecuente de hemorragia digestiva alta: gran hematoma intramural gástrico espontáneo" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 814 "Ancho" => 1653 "Tamanyo" => 178613 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Retroflexed endoscopic appearance of a large mucosal bulge with a violaceous appearance and some areas of eroded mucosa covered with organized clots in the fundus and involving the greater curvature of the proximal stomach.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We present a case of a 78-year-old woman without relevant comorbidities who, on the 5th day of hospitalization for community-acquired pneumonia, developed hematemesis without hemodynamic instability but with a decrease in hemoglobin value (from 10.2<span class="elsevierStyleHsp" style=""></span>g/dL to 8.0<span class="elsevierStyleHsp" style=""></span>g/dL within 24<span class="elsevierStyleHsp" style=""></span>h). No other laboratory parameters were abnormal, including coagulation tests. The only anticoagulant prescribed was enoxaparin, 40<span class="elsevierStyleHsp" style=""></span>mg subcutaneously once daily. An upper gastrointestinal endoscopy under propofol sedation was performed, identifying a large mucosal bulge with a violaceous appearance and areas of eroded mucosa covered with organized clots in the fundus and greater curvature of the proximal stomach (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). No active bleeding, rupture points or other significant findings were noted. Given the endoscopic suspicion of a gastric intramural hematoma (GIH), a contrast-enhanced abdominal computed tomography was performed, confirming the diagnosis of a 67<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>49<span class="elsevierStyleHsp" style=""></span>mm GIH (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). A conservative approach was adopted, and no further episodes of bleeding occurred during the hospital stay.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">To the best of our knowledge, this case is among the very few published reports in which a spontaneous GIH is the etiology of gastrointestinal bleeding.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> While exceedingly rare, this case underscores the importance of including this etiology in the differential diagnosis. Although most intramural gastrointestinal hematomas are located in the esophagus or duodenum, the majority of GIH are associated with coagulopathies. Less frequently, GIH have been associated with trauma, iatrogenic causes (e.g., following endoscopic biopsies), vascular aneurysms, peptic ulcer disease, and pancreatitis.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> Although GIH is often asymptomatic, abdominal pain is the most commonly reported symptom. The differential diagnosis is broad and includes subepithelial lesions, visceral artery aneurysm, extrinsic mass compression, gastric varices, and pancreatic pseudocyst.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a> Computed tomography is considered the most specific and sensitive modality for diagnosing GIH and, when contrast is used, it can also detect active bleeding or the presence of a visceral arterial aneurysm. Upper endoscopy, endoscopic ultrasound, and abdominal ultrasound are also useful modalities in the investigation of GIH.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> There are no established guidelines for the management of GIH.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">1–4</span></a> In most of the cases a conservative approach, including treatment of the underlying disease, correction of coagulopathy and surveillance. Arterial embolization is described as an effective treatment when active bleeding is noted. Surgical intervention is generally recommended in cases of diagnostic uncertainty, suspected complications, extensive gastric wall involvement, persistent bleeding, or failure of minimally invasive treatments.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 814 "Ancho" => 1653 "Tamanyo" => 178613 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Retroflexed endoscopic appearance of a large mucosal bulge with a violaceous appearance and some areas of eroded mucosa covered with organized clots in the fundus and involving the greater curvature of the proximal stomach.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 893 "Ancho" => 800 "Tamanyo" => 71322 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Contrast-enhanced abdominal computed tomography (coronal plane) showing a well-defined, mostly hyperdense mass measuring 67<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>49<span class="elsevierStyleHsp" style=""></span>mm in the greater curvature of the stomach. The mass does not infiltrate the adjoining structures and shows no calcifications, consistent with a gastric intramural hematoma. No evidence of active bleeding was identified.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0025" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Spontaneous gastric intramural hematoma: case report and literature review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "O. Tabbikha" 1 => "H. Maalouf" 2 => "C. Abou-Malhab" 3 => "R. Aby Hadeer" 4 => "R. 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Murawa" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5604/01.3001.0009.9159" "Revista" => array:6 [ "tituloSerie" => "Pol Przegl Chir" "fecha" => "2017" "volumen" => "89" "paginaInicial" => "62" "paginaFinal" => "65" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28537566" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0040" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Spontaneous gastric hematoma as a rare cause of acute abdomen: a case report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "I. Budimir" 1 => "M. Zulec" 2 => "K. Eljuga" 3 => "M. Zidak" 4 => "V. Lisek" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.12998/wjcc.v11.i36.8551" "Revista" => array:6 [ "tituloSerie" => "World J Clin Cases" "fecha" => "2023" "volumen" => "11" "paginaInicial" => "8551" "paginaFinal" => "8556" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/38188220" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/02105705/unassign/S0210570524002577/v1_202410041426/en/main.assets" "Apartado" => null "PDF" => "https://static.elsevier.es/multimedia/02105705/unassign/S0210570524002577/v1_202410041426/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210570524002577?idApp=UINPBA00004N" ]
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| 2024 October | 8 | 4 | 12 |
| 2024 September | 1 | 9 | 10 |
