Esophageal Hematoma

Updated: Dec 09, 2016
  • Author: Jennifer Lynn Bonheur, MD; Chief Editor: Philip O Katz, MD, FACP, FACG  more...
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Overview

Background

Esophageal hematoma is a rare condition that can be spontaneous [1, 2, 3, 4, 5, 6, 7, 8, 9] or secondary to trauma, toxic ingestion, or medical intervention. [10, 11, 12, 13]

Marks and Keet reported a case of a spontaneous intramural hematoma of the esophagus in 1968. [14] This uncommon condition has now been well documented in the literature.

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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. [15, 16]

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.

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Epidemiology

Sex- and Age-related demographics

Approximately 80% of intramural hematomas occur in women.

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

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Prognosis

Long-term results are very good with conservative and supportive treatment. Intermittent odynophagia usually subsides within 2 weeks after the primary event. Recurrence is extremely rare.

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%. [17]

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