Esophageal Hematoma

Esophageal Hematoma

    * Introduction
    * Diagnosis
    * Treatment
Esophageal hematoma is accumulation of blood between the layers of the esophageal wall, a rare pathological condition that can be spontaneous or secondary trauma or medical intervention. Esophageal hematoma associated with esophageal perforation and septic complications: mediastinitis and abscess. The mortality rate is 10-20%. Approximately 80% of the intramural hematomas occur in women. Middle-aged women are affected.
Conservative therapy results in excellent prognosis. Esophageal hematoma usually resolves in weeks -2 to 3 without long term sequelae. Surgery is indicated only in patients with persistent massive haematemesis.
Pathogens.
Vomiting can lead to increased pressure it causes cracks in the lining intraesofagiene (Mallory-Weis Syndrome), transmural perforation (Boerhaave syndrome) or intramural hematoma. Bleeding occurs in the submucous tissue. Achalasia, an esophageal disease is rare in patients with intrinsic esophageal hematoma. Esophageal hematoma can occur in different location of the esophagus. The mechanism can determine the location of the hematoma. For example hematoma by vomiting may occur in the region gastroesophageal junction and a hematoma by ingestion of caustic substances may occur at the point of collapse.
Causes and risk factors.
Esophageal hematoma typically appears during repeated vomiting and although there have been reports of spontaneous hematomas, especially in patients with bleeding disorders. Precipitating or predisposing factors for esophageal hematoma include the following: Such as hemophilia, coagulopathy or taking anticoagulants or aspirin -Instrumentation such as endoscopy or sclerotherapy variceal -Ingestion of foreign bodies, chest trauma Food-injuries as a result of abrasive trauma -Cardioversion and secondary anticoagulative -Ingestion of toxins.
Signs and symptoms.
Spontaneous intramural esophageal hematoma usually present with severe epigastric or chest pain with or without irradiation. Pain is described as having a sudden onset and is aggravated by swallowing. Complete physical examination is necessary. The patient is asked to drink a glass of water to trigger symptoms of dysphagia. This test can help distinguish between cardiac chest pain and esophageal pain. Search this crepitantelor palpation suggesting the presence of air under the skin along the neck, back and chest to exclude esophageal perforation. If the hematoma is associated with septic complications such as perforation occur and abscess mediastinitis. Esophageal perforation mortality is 10-20%.