Spontaneous esophageal intramural hematoma in a young man wrongly diagnosed as achalasia


Intramural hematoma of the esophagus is a rare but well described type of acute injury of the esophageal wall and it is more frequently being recognized throughout the world. Patients usually present with acute retrosternal or epigastric pain, minor hematemesis and dysphagia. The condition is mostly seen in women with abnormal coagulation and it can either occur spontaneous or induced by trauma or transesopha-geal procedures. It is associated with food impaction and vomiting. Esophageal intramural hematoma has also been reported in young and healthy patients. Case reports with coexisting achalasia are limited. Management is conservative and its course is benign.

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Vandermeulen, L. , Mana, F. , Nieboer, K. and Urbain, D. (2012) Spontaneous esophageal intramural hematoma in a young man wrongly diagnosed as achalasia. Open Journal of Gastroenterology, 2, 81-84. doi: 10.4236/ojgas.2012.22017.

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The authors declare no conflicts of interest.


[1] Williams, B. (1957) Oesophageal laceration following remote trauma. The British Journal of Radiology, 30, 666-668. doi:10.1259/0007-1285-30-360-666
[2] Restrepo, C.S., Lemos, D.F., Ocazionez, D., et al. (2008) Intramural hematoma of the esophagus: A pictorial essay. Emergency Radiology, 15, 13-22. doi:10.1007/s10140-007-0675-0
[3] Ouatu-Lascar, R., Bharadhwaj, G. and Triadafilopoulos, G. (2000) Endoscopic appearance of esophageal hema-tomas. World Journal of Gastroenterology, 6, 307-309.
[4] Chu, Y.Y., Sung, K.F., Ng, S.C., et al. (2010) Achalasia combined with esophageal intramural hematoma: Case report and literature review. World Journal of Gastroenterology, 16, 5391-5394. doi:10.3748/wjg.v16.i42.5391
[5] Cheung, J., Müller, N. and Weiss, A. (2006) Spontaneous intramural esophageal hematoma: Case report and review. The Canadian Journal of Gastroenterology, 20, 285-286.
[6] Steadman, C., Kerlin, P., Crimmins, F., et al. (1990) Spontaneous intramural rupture of the oesophagus. Gut, 31, 845-849. doi:10.1136/gut.31.8.845
[7] Biron, C., Bengler, C., Gris, J.C., et al. (1997) Acquired isolated factor VII deficiency during sepsis. Haemostasis, 27, 51-56.
[8] Kerr, W.F. (1980) Spontaneous intramural rupture and intramural haematoma of the oesophagus. Thorax, 35, 890-897. doi:10.1136/thx.35.12.890
[9] Morritt, G.N. and Walbaum, P.R. (1980) Spontaneous dissection of the oesophagus. Thorax, 35, 898-900. doi:10.1136/thx.35.12.898
[10] Shay, S.S., Berendson, R.A. and Johnson, L.F. (1981) Esophageal hematoma. Digestive Diseases and Sciences, 26, 1019-1024. doi:10.1007/BF01314765
[11] Tim, L.O., Segal, I. and Mirwis, J. (1982) Intramural haematoma of the oesophagus. South African Medical Journal, 61,798-800.
[12] Biagi, G., Cappeli, G., Prospersi, L., et al. (1983) Spontaneous intramural haematoma of the oesophagus. Thorax, 38, 394-395. doi:10.1136/thx.38.5.394
[13] Lamont, G., Elliott, S. and Morris, D.L. (1985) Spontaneous intramural oesophageal dissection. Thorax, 40, 558-559. doi:10.1136/thx.40.7.558
[14] Hanson, J.M., Neilson, D. and Pettit, S.H. (1991) Intramural oesophageal dissection. Thorax, 46, 524-527. doi:10.1136/thx.46.7.524
[15] Sen, A. and Lea, R.E. (1993) Spontaneous oesophageal haematoma: A review of the difficult diagnosis. Annals of the Royal College of Surgeons of England, 75, 293-295.
[16] Shimada, R., Kimura, K., Higashi, K., et al. (1993) Spontaneous submucosal dissection of the esophagus. Internal Medicine, 32, 795-797.
[17] Linskens, R.K., Tuynman, H.A., Molenaar, M.A., et al. (1996) Acute transit symptoms caused by spontaneous rupture of the esophagus. Nederlands Tijdschrift voor Geneeskunde, 140, 2243-2245.
[18] Phan, G.Q. and Heitmiller, R.F. (1997) Intramural esophageal dissection. The Annals of Thoracic Surgery, 63, 1785-1786. doi:10.1016/S0003-4975(97)83865-9
[19] McIntyre, A.S., Ayres, R., Atherton, J., et al. (1998) Dissecting intramural haematoma of the oesophagus. Oxford Journal, 91, 701-705. doi:10.1093/qjmed/91.10.701
[20] Yuen, E.H., Yang, W.T., Lam, W.W., et al. (1998) Spontaneous intramural haematoma of the oesophagus: CT and MRI appearances. Australasian Radiology, 42, 139-142. doi:10.1111/j.1440-1673.1998.tb00591.x
[21] Modi, P., Edwards, A., Fox, B., et al. (2005) Dissecting intramural haematoma of the oesophagus. European Journal of Cardiothoracic Surgery, 27, 171-173. doi:10.1016/j.ejcts.2004.09.012
[22] Thomasset, S.C. and Berry, D.P. (2005) Spontaneous intramural esophageal hematoma. Journal of Gastrointestinal Surgery, 9, 155-156. doi:10.1016/j.gassur.2004.05.015
[23] Saito, S., Hosoya, Y., Kurashina, K., et al. (2005) Esophageal submucosal hematoma. Esophagus, 2, 155-159. doi:10.1007/s10388-005-0049-1
[24] Rossaak, J., Wakeman, C. and Coulter, G. (2006) Spontaneous submucosal haematoma of the oesophagus. The New Zealand Medical Journal, 119, 2342.
[25] Hagel, J., Bicknell, S.G. and Haniak, W. (2007) Imaging management of spontaneous giant esophageal intramural hematoma. Canadian Association of Radiologists Journal, 58, 76-78.
[26] Soulellis, C.A., Hilzenrat, N. and Levental, M. (2008) Intramucosal esophageal dissection leading to esophageal perforation. Gastroenterology & Hepatology, 4, 362-365.
[27] Abbey, P., Sharma, R. and Garg, P.K. (2009) Spontaneous intramural haematoma of the oesophagus: Complete resolution on follow-up magnetic resonance imaging. Singapore Medical Journal, 50, 318-320.
[28] Chiu, Y.H., Chen, J.D., Hsu, C.Y., et al. (2009) Spontaneous esophageal injury: Esophageal intramural hematoma. Journal of the Chinese Medical Association, 72, 498-500. doi:10.1016/S1726-4901(09)70416-2
[29] Kim, E.S., Keum, B., Seo, Y.S., et al. (2009) Intramural esophageal dissection resolved by endoscopic treatment. Endoscopy, 41, 313-314. doi:10.1055/s-0029-1215256
[30] Beumer, J.D., Devitt, P.G. and Thompson, S.K. (2010) Intramural oesophageal dissection. ANZ Journal of Surgery, 80, 91-95. doi:10.1111/j.1445-2197.2009.05179.x
[31] Cho, C.M., Ha, S.S., Tak, W.Y., et al. (2002) Endoscopic incision of a septum in a case of spontaneous intramural dissection of the esophagus. Journal of Clinical Gastroenterology, 35, 3873-90. doi:10.1097/00004836-200211000-00006
[32] Kim, S.H. and Lee, S. (2005) Circumferential intramural esophageal dissection successfully treated by endoscopic procedure and metal stent insertion. Journal of Gastroenterology, 40, 1065-1069. doi:10.1007/s00535-005-1692-y
[33] Benatta, M.A., Grimaud, J.C., Kaci, M., et al. (2010) Intramural esophageal dissection due to pharyngeal abscess treated by endoscopic esophageal transaction: A case report. Gastroenterologie Clinique et Biologique, 34, 329-331. doi:10.1016/j.gcb.2010.04.009
[34] Nagai, T., Torishima, R., Nakashima, H., et al. (2004) Spontaneous Esophageal submucosal hematoma in which the course could be observed endoscopically. Internal Medicine, 43, 461-467. doi:10.2169/internalmedicine.43.461

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