Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 26, 2023; 11(36): 8551-8556
Published online Dec 26, 2023. doi: 10.12998/wjcc.v11.i36.8551
Spontaneous gastric hematoma as a rare cause of acute abdomen: A case report
Ivan Budimir, Mirna Žulec, Ksenija Eljuga, Marcel Židak, Valentino Lisek
Ivan Budimir, Department for Plastic and Reconstructive Surgery, University Hospital Dubrava, Zagreb 10000, Croatia
Ivan Budimir, Zagreb School of Medicine, University of Zagreb, Zagreb 10000, Croatia
Ivan Budimir, Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, Osijek 31000, Croatia
Mirna Žulec, Department of Nursing, Catholic University of Croatia, Zagreb 10000, Croatia
Ksenija Eljuga, Department of Nursing, Bjelovar University of Applied Sciences, Bjelovar 43000, Croatia
Marcel Židak, Department of Surgery, University of Zagreb, Dubrava University Hospital, Zagreb 10000, Croatia
Valentino Lisek, Department of Abdominal Surgery, University Hospital Dubrava, Zagreb 10000, Croatia
Valentino Lisek, Doctoral Study of Biomolecular Sciences, Josip Juraj Strossmayer University of Osijek, Osijek 31000, Croatia
Author contributions: Budimir I contributed to data collection, conceptualization, writing and editing; Žulec M and Eljuga K contributed to data collection and data analysis; Židak M and Lisek V contributed to conceptualization; Lisek V contributed to supervision and editing; all authors read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
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: Ivan Budimir, MD, PhD, Surgeon, Department for Plastic and Reconstructive Surgery, University Hospital Dubrava, Avenija Gojka Šuška, Zagreb 10000, Croatia. ivan.budimir.marat@gmail.com
Received: September 23, 2023
Peer-review started: September 23, 2023
First decision: November 17, 2023
Revised: December 2, 2023
Accepted: December 8, 2023
Article in press: December 8, 2023
Published online: December 26, 2023
Processing time: 89 Days and 16.9 Hours
Abstract
BACKGROUND

Spontaneous gastric hematoma is an exceedingly rare condition characterized by the accumulation of blood within the gastric wall without any apparent iatrogenic or traumatic cause. Coagulopathies are the most frequent cause of gastric hematomas. However, other causes include amyloidosis, pancreatitis, visceral vascular aneurysms, endoscopy complications and others. The pathophysiology of spontaneous gastric hematoma is not completely understood. However, it is postulated that it is caused by disruption of submucosal vessels that leads to dissection of the muscularis layer and formation of false lumen. The rarity of this condition increases the challenge of diagnosis, and there is no standard treatment protocol.

CASE SUMMARY

We present the case of a spontaneous gastric hematoma in a 22-year-old male. He presented to our emergency department complaining of pain in the left flank area lasting for 2 wk. There was no history of trauma, anticoagulant medications or endoscopy procedures. His hemoglobin and hematocrit levels were slightly lower than normal. Multi-slice computed tomography, ultrasound and endoscopy confirmed a gastric intramural hematoma. We recommended conservative treatment because there was no hemodynamic instability nor significant bleeding. The patient responded well, and there were no unexpected events. At the 3-mo follow-up, the ultrasound examination revealed complete regression of the hematoma.

CONCLUSION

After reviewing the literature and our experience, we recommend that more of these cases should be treated conservatively. The tendency to treat these cases with potentially burdensome procedures such as total or subtotal gastrectomy should be significantly reduced.

Keywords: Spontaneous; Intramural hematoma; Stomach; Acute abdomen; Conservative treatment; Case report

Core Tip: It is our intention to emphasize spontaneous gastric intramural hematoma as one of possible causes of acute abdomen. Also we would like to underline the option for conservative treatment of this condition. With our experience and by reviewing the literature we are under impression that majority of these cases could have been treated conservatively and number of surgical procedures could be reduced to some extent.