Uncommon cause of upper gastrointestinal bleeding: Spontaneous large gastric intramural hematoma

Lima Capela, Tiago; Cúrdia Gonçalves, Tiago; Magalhães, Joana; Cotter, José

doi:10.1016/j.gastrohep.2024.502259

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No other laboratory parameters were abnormal, including coagulation tests. The only anticoagulant prescribed was enoxaparin, 40mg 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 67mm×49mm 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.<elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia>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">1</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">2</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">3</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">2</a> There are no established guidelines for the management of GIH.<a class="elsevierStyleCrossRefs" href="#bib0025">1–4</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." "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" => "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." ] ] 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" => "Contrast-enhanced abdominal computed tomography (coronal plane) showing a well-defined, mostly hyperdense mass measuring 67mm×49mm 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." ] ] ] "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. Wakim" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Cureus" "fecha" => "2022" "volumen" => "14" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0030" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Gastric intramural hematoma: a case report and literature review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "V. Dhawan" 1 => "A. Mohamed" 2 => "R.N. Fedorak" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1155/2009/503129" "Revista" => array:6 [ "tituloSerie" => "Can J Gastroenterol" "fecha" => "2009" "volumen" => "23" "paginaInicial" => "19" "paginaFinal" => "22" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19172203" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0035" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intramural gastric hematoma imitating a gastrointestinal stromal tumor – case report and literature review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. Spychala" 1 => "P. Nowaczyk" 2 => "A. Budnicka" 3 => "E. Antoniewicz" 4 => "D. 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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