Massive bleeding due to dissecting esophageal hematoma: A diagnostic dilemma

Year 2018, , 66 - 68, 25.09.2018

Şehmus Ölmez , Adnan Taş , Banu Kara Bünyamin Sarıtaş

https://doi.org/10.17940/endoskopi.459597

Abstract

The esophagus may be the origin of acute chest pain that is clinically indistinguishable from that caused due to other cardiothoracic emergencies. Dissecting esophageal hematoma is an extremely rare condition generally presenting with severe acute chest pain, and it might also cause vomiting, dysphagia, odynophagia, and hematemesis. Endoscopy is safe and can be used to confirm the diagnosis when a hematoma within the esophageal wall or later appearances of a longitudinal dissection are observed. Dissecting esophageal hematoma has an excellent prognosis, and it is usually treated conservatively after excluding esophageal perforation. We report a case of a 44-year-old male patient with Behçet’s disease who was taking colchicine, coumadin, and enoxaparin, and we initially suspected that this patient had pulmonary embolism or pulmonary artery aneurysm, but later, we found that he had dissecting esophageal hematoma. Furthermore, we observed that the laceration did not heal completely even 6 weeks after the conservative treatment.

Keywords

Dissecting esophageal hematoma, masssive bleeding, prognosis

Dissekan özofagus hematomuna bağlı masif kanama: Tanıda ikilem

Abstract

Özofagus klinik olarak diğer kardiyotorasik acillerle karışabilen akut göğüs ağrısı nedenlerinden olabilir. Dissekan özofagus hematomu oldukça nadir görülen bir durum olup, genellikle ciddi göğüs ağrısı ile karşımıza çıkabilir. Kusma, disfaji, odinofaji ve hematemezle de karşımıza çıkabilir. Endoskopi güvenli bir işlem olup özofagus duvarında hematom veya daha sonraki longitudinal disseksiyonu göstererek tanıyı kesinleştirir. Disekan özofagus hematomu mükemmel bir prognoza sahiptir ve genellikle özofagus perforasyonu dışlanırsa konservatif olarak tedavi edilir. Burada 44 yaşında, Behçet Hastalığı tanısı ile izlenen ve kolşisin, kumadin ve enoksaparin tedavisi alan ve öncelikle pulmoner emboli veya pulmoner arter anevrizmasından şüphelenilen ancak disekan özofagus hematomu tanısı koyduğumuz bir olguyu sunacağız. Ek olarak, konservatif tedavi sonrası altıncı haftada laserasyonun tamamen iyileşmediğini gösterdik.

Keywords

Dissekan özofagus hematomu, masif kanama, prognoz

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