eMedicine Specialties > Gastroenterology > Esophagus

Esophageal Hematoma

Author: Jennifer Lynn Bonheur, MD, Fellow, Department of Internal Medicine, Division of Gastroenterology, Lenox Hill Hospital
Coauthor(s): Klaus Radebold, MD, PhD, Research Associate, Department of Surgery, Yale University School of Medicine
Contributor Information and Disclosures

Updated: Jul 20, 2006

Introduction

Background

Esophageal hematoma is a rare condition that can be spontaneous or secondary to trauma, toxic ingestion, or medical intervention.

Marks and Keet reported a case of a spontaneous intramural hematoma of the esophagus in 1968. This uncommon condition has now been well documented in the literature.

Pathophysiology

Vomiting can lead to increased intraesophageal pressure that may result in mucosal tears (Mallory-Weiss syndrome), transmural perforation (Boerhaave syndrome), or intramural hematoma of the esophagus. The hemorrhage occurs within submucosal tissues.

Intrinsic esophageal disease, such as achalasia, is rare in patients with esophageal hematoma.

Esophageal hematoma may occur at various sites of the esophagus. The mechanism producing the hematoma may determine the site. For example, a hematoma from vomiting would be in the region of the esophagogastric junction, and a hematoma from a caustic substance might be at points of narrowing.

Mortality/Morbidity

  • If the hematoma is associated with a perforation of the esophagus, septic complications (eg, mediastinitis, abscess formation) are likely to occur.
  • The mortality rate associated with esophageal perforations is about 10-20%.

Sex

Approximately 80% of intramural hematomas occur in women.

Age

Primarily middle-aged women are affected. In a literature review of 31 patients, the mean age was 67 years.

Clinical

History

  • Spontaneous intramural hematoma of the esophagus usually presents initially with severe retrosternal or epigastric pain with or without radiation. The pain is described as abrupt in onset and is aggravated by swallowing.
  • In one meta-analysis, 32% of patients presented with the triad of chest pain, hematemesis, and dysphagia; 99% of patients had at least one of these symptoms.

Physical

A complete and thorough physical examination should be performed.

  • Asking a patient to take a sip of water as part of the general examination may help to unmask symptoms of dysphagia. This may help toward distinguishing between cardiac chest pain and an esophageal disorder causing chest pain.
  • Palpation looking for the presence of crepitus (suggesting the presence of air under the skin) along the neck, back, and chest can help to rule in or out the presence of an esophageal perforation.

Causes

Esophageal hematomas typically occur in the setting of vomiting or retching, although spontaneous hematomas (more commonly in patients with bleeding disorders) may also occur.

  • Precipitating or predisposing factors to esophageal hematoma include the following:
    • Coagulopathies, such as hemophilia, or treatment with anticoagulants or aspirin
    • Instrumentation, such as with endoscopy or variceal sclerotherapy
    • Foreign body ingestion
    • Chest trauma
    • Food-induced injury, as a result of abrasive trauma by foodstuffs
    • Cardioversion and subsequent anticoagulation
    • Toxin ingestion

More on Esophageal Hematoma

Overview: Esophageal Hematoma
Differential Diagnoses & Workup: Esophageal Hematoma
Treatment & Medication: Esophageal Hematoma
Follow-up: Esophageal Hematoma
References
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References

  1. Adeonigbagbe O, Khademi A, Washington M. Spontaneous esophageal hematoma. Am J Gastroenterol. Dec 1999;94(12):3655. [Medline].

  2. Alani FS. Extensive oesophageal haematoma with haematemesis treated by sclerosant injections. Endoscopy. Feb 1995;27(2):213-4. [Medline].

  3. Amott DH, Wright GM. Dissecting haematoma of the oesophagus masquerading as acute myocardial infarction. The Medical Journal of Australia. 2006;184 (4):182-183.

  4. Baehr PH, McDonald GB. Esophageal Disorders Caused by Infection, Systemic Illness, Medications, Radiation, and Trauma. Sleisenger and Fordtran's: Gastrointestinal and Liver Disease, 6th Edition. 1998;1:534.

  5. Blaivas M, Hom DB, Younger JG. Thyroid gland hematoma after blunt cervical trauma. Am J Emerg Med. Jul 1999;17(4):348-50. [Medline].

  6. Bonnette P, Lansac E, Fritsch J. [Intramural hematoma of the esophagus: a rare diagnosis]. Rev Mal Respir. Dec 1999;16(6):1147-50. [Medline].

  7. Chen TA, Lo GH, Lai KH. Spontaneous rupture of iatrogenic intramural hematoma of esophagus during endoscopic sclerotherapy. Gastrointest Endos. Dec 1999;50(6):850-1. [Medline].

  8. Cheung J, Muller N, Weiss A. Spontaneous intramural esophageal hematoma: case report and review. Can J Gastroenterol. Apr 2006;20(4):285-6.

  9. Cullen SN, Chapman RW. Dissecting intramural haematoma of the oesophagus exacerbated by heparin therapy. QJM. Feb 1999;92(2):123-4. [Medline].

  10. Cullen SN, McIntyre AS. Dissecting intramural haematoma of the oesophagus. Eur J Gastroenterol Hepatol. Oct 2000;12(10):1151-62.

  11. Faigel DO. Miscellaneous Disease of the Esophagus: Systemic, Dermatologic Disease, Foreign Bodies and Physical Injury. Textbook of Gastroenterology, 4th Edition. 2003;1:1269.

  12. Folan RD, Smith RE, Head JM. Esophageal hematoma and tear requiring emergency surgical intervention. A case report and literature review. Dig Dis Sci. Dec 1992;37(12):1918-21. [Medline].

  13. Freeman AH, Dickinson RJ. Spontaneous intramural oesophageal haematoma. Clin Radiol. Nov 1988;39(6):628-34. [Medline].

  14. Geller A, Gostout CJ. Esophagogastric hematoma mimicking a malignant neoplasm: clinical manifestations, diagnosis, and treatment. Mayo Clin Proc. Apr 1998;73(4):342-5.

  15. Hiller N, Zagal I, Hadas-Halpern I. Spontaneous intramural hematoma of the esophagus. Am J Gastroenterol. Aug 1999;94(8):2282-4. [Medline].

  16. Lu MS, Liu YH, Liu HP. Spontaneous intramural esophageal hematoma. Ann Thorac Surg. Jul 2004;78(1):343-5.

  17. Maher MM, Murphy J, Dervan P. Aorto-oesophageal fistula presenting as a submucosal oesophageal haematoma. Br J Radiol. Sep 1998;71(849):972-4. [Medline].

  18. Marks IN, Keet AD. Intramural rupture of the oesophagus. Br Med J. Aug 31 1968;3(617):536-7. [Medline].

  19. McIntyre AS, Ayres R, Atherton J. Dissecting intramural haematoma of the oesophagus. QJM. Oct 1998;91(10):701-5. [Medline].

  20. Meulman N, Evans J, Watson A. Spontaneous intramural haematoma of the oesophagus: a report of three cases and review of the literature. Aust N Z J Surg. Mar 1994;64(3):190-3. [Medline].

  21. Skillington PD, Matar KS, Gardner MA. Intramural haematoma of the oesophagus complicated by perforation. Aust N Z J Surg. May 1989;59(5):430-2. [Medline].

  22. Thomasset SC, Berry DP. Spontaneous intramural esophageal hematoma. J Gastrointest Surg. Jan 2005;9(1):155-6.

  23. Tong M, Hung WK, Law S. Esophageal hematoma. Dis Esophagus. 2006;19(3):200-2.

  24. Younes Z, Johnson DA. The spectrum of spontaneous and iatrogenic esophageal injury: perforations, Mallory-Weiss tears, and hematomas. J Clin Gastroenterol. Dec 1999;29(4):306-17. [Medline].

  25. Yuen EH, Yang WT, Lam WW. Spontaneous intramural haematoma of the oesophagus: CT and MRI appearances. Australas Radiol. May 1998;42(2):139-42. [Medline].

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Further Reading

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Keywords

esophageal apoplexy, esophageal mucosal tears, Mallory-Weiss syndrome, transmural perforation, Boerhaave syndrome, intramural hematoma of the esophagus, esophageal perforation, mediastinitis, abscess formation, vomiting, dysphagia, odynophagia, hematemesis, severe acute chest pain

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Contributor Information and Disclosures

Author

Jennifer Lynn Bonheur, MD, Fellow, Department of Internal Medicine, Division of Gastroenterology, Lenox Hill Hospital
Jennifer Lynn Bonheur, MD is a member of the following medical societies: American Gastroenterological Association, American Society for Gastrointestinal Endoscopy, New York Academy of Sciences, and Sigma Xi
Disclosure: Nothing to disclose.

Coauthor(s)

Klaus Radebold, MD, PhD, Research Associate, Department of Surgery, Yale University School of Medicine
Klaus Radebold, MD, PhD is a member of the following medical societies: American Gastroenterological Association and New York Academy of Sciences
Disclosure: Nothing to disclose.

Medical Editor

Maurice A Cerulli, MD, FACG, Chief, Division of Gastroenterology and Hepatology, Associate Professor of Clinical Medicine, Department of Internal Medicine, Division of Gastroenterology, New York Methodist Hospital, Cornell University
Maurice A Cerulli, MD, FACG is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, American Medical Association, and American Society for Gastrointestinal Endoscopy
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Simmy Bank, MD, Chair, Professor, Department of Internal Medicine, Division of Gastroenterology, Long Island Jewish Hospital, Albert Einstein College of Medicine
Disclosure: Nothing to disclose.

CME Editor

Alex J Mechaber, MD, FACP, Assistant Dean for Medical Curriculum, Associate Professor of Medicine, Division of General Internal Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD, Clinical Professor of Medicine, Drexel University College of Medicine; Consulting Staff, Department of Medicine, Section of Gastroenterology and Hepatology, Hospital of the Medical College of Pennsylvania
Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law Medicine and Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
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