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©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
Hemorrhagic shock due to submucosal esophageal hematoma along with mallory-weiss syndrome: A case report
Jiro Oba, Daisuke Usuda, Shiho Tsuge, Riki Sakurai, Kenji Kawai, Shun Matsubara, Risa Tanaka, Makoto Suzuki, Hayabusa Takano, Shintaro Shimozawa, Yuta Hotchi, Kenki Usami, Shungo Tokunaga, Ippei Osugi, Risa Katou, Sakurako Ito, Kentaro Mishima, Akihiko Kondo, Keiko Mizuno, Hiroki Takami, Takayuki Komatsu, Tomohisa Nomura, Manabu Sugita
Jiro Oba, Daisuke Usuda, Shiho Tsuge, Riki Sakurai, Kenji Kawai, Shun Matsubara, Risa Tanaka, Makoto Suzuki, Hayabusa Takano, Shintaro Shimozawa, Yuta Hotchi, Kenki Usami, Shungo Tokunaga, Ippei Osugi, Risa Katou, Sakurako Ito, Kentaro Mishima, Akihiko Kondo, Keiko Mizuno, Hiroki Takami, Takayuki Komatsu, Tomohisa Nomura, Manabu Sugita, Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-8521, Tokyo, Japan
Takayuki Komatsu, Faculty of Medicine, Juntendo University, Bunkyo-ku 113-8421, Tokyo, Japan
Author contributions: Oba J wrote the manuscript; Usuda D, Tsuge S, Sakurai R, Kawai K, Matsubara S, Tanaka R, Suzuki M, Takano H, Shimozawa S, Hotchi Y, Usami K, Tokunaga S, Osugi I, Katou R, Ito S, Asako S, Mishima K, Kondo A, Mizuno K, Takami H, Komatsu T, Nomura T, and Sugita M proofread and revised the manuscript; all authors approved the final version to be published.
Informed consent statement: Written informed consent was obtained from the patient and his family for publication of this case report and any accompanying images. Both written and verbal informed consent were obtained from the patient and his family for publication of this case report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Jiro Oba, MD, PhD, Associate Professor, Doctor, Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, 3-1-10, Takanodai, Nerima-ku 177-8521, Tokyo, Japan.
j.oba@juntendo-nerima.jp
Received: May 14, 2022
Peer-review started: May 14, 2022
First decision: July 29, 2022
Revised: August 8, 2022
Accepted: August 17, 2022
Article in press: August 17, 2022
Published online: September 26, 2022
Processing time: 120 Days and 2.1 Hours
BACKGROUND
Esophageal submucosal hematoma is a rare condition. Although the exact etiology remains uncertain, vessel fragility with external factors is believed to have led to submucosal bleeding and hematoma formation; the vessel was ruptured by a sudden increase in pressure due to nausea, and the hematoma was enlarged by antiplatelet or anticoagulant therapy. Serious conditions are rare, with a better prognosis. We present the first known case of submucosal esophageal hematoma-subsequent hemorrhagic shock due to Mallory-Weiss syndrome.
CASE SUMMARY
A 73-year-old female underwent endovascular treatment for an unruptured cerebral aneurysm. The patient received aspirin and clopidogrel before surgery and heparin during surgery, and was well during the surgery. Several hours after returning to the ICU, she complained of chest discomfort, vomited 500 mL of fresh blood, and entered hemorrhagic shock. Esophageal submucosal hematoma with Mallory-Weiss syndrome was diagnosed through an endoscopic examination and computed tomography. In addition to a massive fluid and erythrocyte transfusion, we performed a temporary compression for hemostasis with a Sengstaken-Blakemore (S-B) tube. Afterwards, she became hemodynamically stable. On postoperative day 1, we performed an upper gastrointestinal endoscopy and confirmed no expansion of the hematoma nor any recurring bleeding; therefore, we removed the S-B tube and clipped the gastric mucosal laceration at the esophagogastric junction. We started oral intake on postoperative day 10. The patient made steady progress, and was discharged on postoperative day 33.
CONCLUSION
We present the first known case of submucosal esophageal hematoma subsequent hemorrhagic shock due to Mallory-Weiss syndrome.
Core Tip: Esophageal submucosal hematoma is a rare condition. Although the exact etiology remains uncertain, vessel fragility with external factors is considered to have led to submucosal bleeding and hematoma formation, with the vessel ruptured by a sudden increase in pressure due to nausea, and the hematoma was enlarged by antiplatelet or anticoagulant therapy. Serious conditions are rare, with a better prognosis. We present the first known case of submucosal esophageal hematoma-subsequent hemorrhagic shock due to Mallory-Weiss syndrome. In addition, submucosal esophageal hematoma after coiling embolization for unruptured cerebral aneurysm is a very rare event, so there is also value in reporting this event.
