Desmorat H, Cales P, Vinel J P, Maquin P, Caucanas J P, Combis J M, Pascal J P
Service d'Hépato-Gastroentérologie, Hôpital Purpan, Toulouse.
Gastroenterol Clin Biol. 1990;14(6-7):581-5.
Obstructive intramural hematoma of the esophagus is an unusual complication of endoscopic sclerotherapy. We report three patients with liver cirrhosis who experienced such a complication. In our series, the frequency was 1.6 percent. A few hours after sclerotherapy, all three patients complained of low retrosternal pain, dysphagia and hypersialorrhea. Endoscopy was performed in two patients and showed a typical bluish submucosal mass occupying the esophageal lumen. Outcome was favorable in all patients within one week of conservative treatment. We hypothesized that hematoma could be ascribed to variceal puncture. The extension of the hematoma with dissection of the esophageal wall which had been fragilized by previous sclerotherapy sessions could have been facilitated by impaired coagulation.
食管壁内阻塞性血肿是内镜硬化治疗的一种罕见并发症。我们报告了3例肝硬化患者发生了这种并发症。在我们的病例系列中,发生率为1.6%。硬化治疗后数小时,所有3例患者均主诉胸骨后低位疼痛、吞咽困难和唾液分泌过多。2例患者接受了内镜检查,显示一个典型的蓝色黏膜下肿物占据食管腔。所有患者经保守治疗1周内预后良好。我们推测血肿可能归因于曲张静脉穿刺。先前硬化治疗导致食管壁变脆弱,凝血功能受损可能促使血肿扩展并伴有食管壁剥离。