Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 16, 2021; 9(20): 5683-5688
Published online Jul 16, 2021. doi: 10.12998/wjcc.v9.i20.5683
Submucosal hematoma with a wide range of lesions, severe condition and atypical clinical symptoms: A case report
Liang Liu, Xing-Jie Shen, Li-Jun Xue, Shu-Kun Yao, Jing-Yu Zhu
Liang Liu, Xing-Jie Shen, Li-Jun Xue, Jing-Yu Zhu, Department of Gastroenterology, Central Hospital Affiliated to Shandong First Medical University, Jinan 250011, Shandong Province, China
Liang Liu, Xing-Jie Shen, Li-Jun Xue, Jing-Yu Zhu, Department of Gastroenterology, Jinan Central Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250011, Shandong Province, China
Shu-Kun Yao, Department of Gastroenterology, China-Japan Friendship Hospital, Beijing 100029, China
Author contributions: Xue LJ and Liu L have contributed equally to this work; Xue LJ, Zhu JY, and Shen XJ participated in collecting the data; Zhu JY and Liu L drafted the manuscript; Yao SK revised the article; all authors read and approved the final manuscript.
Supported by Shandong Province Medical and Health Science and Technology Development Plan (Clinical Study of Minimally Invasive Treatment Under Endoscopy of Gastrointestinal Mucosa), No. 2016WS0124.
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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jing-Yu Zhu, MD, Chief Doctor, Department of Gastroenterology, Jinan Central Hospital, Cheeloo College of Medicine, Shandong University, No. 105 Jiefang Road, Lixia District, Jinan 250011, Shandong Province, China. jingyu_esd@126.com
Received: March 4, 2021
Peer-review started: March 4, 2021
First decision: April 29, 2021
Revised: May 5, 2021
Accepted: May 26, 2021
Article in press: May 26, 2021
Published online: July 16, 2021
Processing time: 124 Days and 20.4 Hours
Abstract
BACKGROUND

Submucosal hematoma (SH) is one of the rare causes of upper gastrointestinal bleeding. As a rare and critical disease in clinical practice, it should be paid more attention to by clinicians to avoid missed diagnosis and misdiagnosis. Most of the esophageal submucosal hematomas have clear causes, including retrosternal pain, dysphagia, etc. Here, we report a rare case of SH extending from the hypopharynx to the lower esophagus caused by oral administration of hirudin and panax notoginseng powder, with atypical clinical manifestation. Such a long submucosal hematoma has rarely been reported.

CASE SUMMARY

The patient was a 60-year-old male with a history of gastritis, hypertension, coronary heart disease, and coronary stent implantation. The patient developed chest tiredness and heartburn after taking 10 capsules of a homemade mixture of hirudin and notoginseng powder in the previous 2 d. He did not have hematemesis or black stool. Gastroscopy and chest computed tomography confirmed the diagnosis of SH, which ranged from the pharynx to the lower esophagus and was 35-40 cm in length. After the diagnosis was confirmed, we performed active conservative treatment on the patient, and the patient recovered well and remained asymptomatic during the 26-mo follow-up.

CONCLUSION

SH is rare, and cases with atypical clinical symptoms may lead to misdiagnosis and missed diagnosis. Ignorance of this disease can lead to serious clinical consequences. Conservative therapy is effective and the prognosis is good.

Keywords: Submucosal hematoma; Hypopharynx; lower esophagus; hirudin and panax notoginseng powder; Gastroscopy; Computed tomography; Case report

Core Tip: Esophageal submucosal hematoma is a rare cause of upper gastrointestinal bleeding. As an acute and critical disease rarely seen in clinic, it needs to be known to clinicians. At present, submucosal hematoma caused by oral mixture of hirudin and notoginseng powder has not been reported at home and abroad. The patient was a 60-year-old male who had taken 10 capsules of hirudin and notoginseng powder mixture made by himself 2 d ago and developed atypical clinical manifestations such as chest tiredness and heartburn. Endoscopy shows that the hematoma extended from the pharynx to the lower esophagus, and the length was 35-40 cm. Such a long submucosal hematoma is also rare.