Şehmus ÖLMEZ, Adnan TAŞ, Banu KARA, Bünyamin SARITAŞ

Dissekan özofagus hematomuna bağlı masif kanama: Tanıda ikilem

Özofagus klinik olarak diğer kardiyotorasik acillerle karışabilen akut göğüs ağrısı nedenlerinden olabilir. Dissekan özofagus hematomu oldukça nadir görülen bir durum olup, genellikle ciddi göğüs ağrısı ile karşımıza çıkabilir. Kusma, disfaji, odinofaji ve hematemezle de karşımıza çıkabilir. Endoskopi güvenli bir işlem olup özofagus duvarında hematom veya daha sonraki longitudinal disseksiyonu göstererek tanıyı kesinleştirir. Disekan özofagus hematomu mükemmel bir prognoza sahiptir ve genellikle özofagus perforasyonu dışlanırsa konservatif olarak tedavi edilir. Burada 44 yaşında, Behçet Hastalığı tanısı ile izlenen ve kolşisin, kumadin ve enoksaparin tedavisi alan ve öncelikle pulmoner emboli veya pulmoner arter anevrizmasından şüphelenilen ancak disekan özofagus hematomu tanısı koyduğumuz bir olguyu sunacağız. Ek olarak, konservatif tedavi sonrası altıncı haftada laserasyonun tamamen iyileşmediğini gösterdik.

Anahtar Kelimeler:

Dissekan özofagus hematomu, masif kanama, prognoz

Massive bleeding due to dissecting esophageal hematoma: A diagnostic dilemma

The esophagus may be the origin of acute chest pain that is clinically indistinguishable from that caused due to other cardiothoracic emergencies. Dissecting esophageal hematoma is an extremely rare condition generally presenting with severe acute chest pain, and it might also cause vomiting, dysphagia, odynophagia, and hematemesis. Endoscopy is safe and can be used to confirm the diagnosis when a hematoma within the esophageal wall or later appearances of a longitudinal dissection are observed. Dissecting esophageal hematoma has an excellent prognosis, and it is usually treated conservatively after excluding esophageal perforation. We report a case of a 44-year-old male patient with Behçet’s disease who was taking colchicine, coumadin, and enoxaparin, and we initially suspected that this patient had pulmonary embolism or pulmonary artery aneurysm, but later, we found that he had dissecting esophageal hematoma. Furthermore, we observed that the laceration did not heal completely even 6 weeks after the conservative treatment.

Keywords:

Dissecting esophageal hematoma, masssive bleeding, prognosis,

PDF

___

References 1. Mosimann F, Brönnimann B. Intramural haematoma of the oesophagus complicating sclerotherapy of varices. Gut 1994;35:130-1.
2. Restrepo CS, Lemos DF, Ocazionez D, et al. Intramural hematoma of the esophagus: a pictorial essay. Emerg Radiol 2008;15:13-22.
3. Hiller N, Zagal I, Hadas-Halpern I. Spontaneous intramural hematoma of the esophagus. Am J Gastroenterol 1999;94:2282-4.
4. Jalihal A, Jamaludin AZ, Sankarakumar S, Chong VH. Intramural hema¬toma of the esophagus: a rare cause of chest pain. Am J Emerg Med 2008;26:843.e1-2.
5. Jung KW, Lee OJ. Extensive spontaneous submucosal dissection of the esophagus: long-term sequential endoscopic observation and treatment. Gastrointest Endosc 2002;55:262-5.
6. Younes Z, Johnson DA. The spectrum of spontaneous and iatrogenic esophageal injury: perforations, Mallory-Weiss tears, and hematomas. J Clin Gastroenterol 1999;29:306-17.
7. Jeong ES, Kim MJ, Yoo SH, et al. Intramural Hematoma of the Esophagus after Endoscopic Pinch Biopsy. Clin Endosc 2012;45:417-20.
8. Chiu YH, Chen JD, Hsu CY, et al. Spontaneous esophageal injury: esophageal intramural hematoma. J Chin Med Assoc 2009;72:498-500.
9. Shim J, Jang JY, Hwangbo Y, et al. Recurrent massive bleeding due to dissecting intramural hematoma of the esophagus: treatment with therapeutic angiography. World J Gastroenterol 2009;15:5232-5.
10. McIntyre AS, Ayres R, Atherton J, et al. Dissecting intramural haematoma of the oesophagus. Q J Med 1998;91:701-5.