Borges Alana Costa, Cury Marcelo de Sousa, de Carvalho Gilberto F, Furlani Stella Maria Torres
Zilda Arns Hospital and Maternity, Gastrointestinal Endoscopy, 145 Lineu Machado Av, 60520-100, Fortaleza, CE, Brazil.
SCOPE Gastrointestinal Endoscopy Unit, Gastrointestinal Endoscopy, 1148 Maracaju St, 79002-212, Campo Grande, MS, Brazil.
Ann Med Surg (Lond). 2018 Sep 27;36:5-9. doi: 10.1016/j.amsu.2018.09.026. eCollection 2018 Dec.
Intramural hematomas of the gastrointestinal tract are uncommom, usually located in the esophagus or duodenum, with idiophatic or secondary causes. We present a very rare case of gastric intramural hematoma caused by an unpublished etiology, with literature review.
An elderly woman suffered acute thoracic aorta dissection followed by gastric intramural hematoma, diagnosed through endoscopy and computed tomography angiography. The treatment included endovascular aortic repair and conservative management.
The postulated mechanism for the bleeding in gastric intramural hematoma is shredding of terminal arteries at the point of penetration into the muscular layer with subsequent dissection of the muscularis propria from the submucosa. The most frequently cited risk factor is hemorrhagic diathesis/anticoagulant use and the main etiologies are trauma and post-interventional endoscopy. In the diagnosis work-up, computed tomography is the method of choice, usually associated with endoscopy. There is no standard of care for such rare condition. Thus, treatment may be cause-dependent, ranging from conservative to minimally invasive and/or surgery.
Gastric intramural hematoma is a rare disorder with many causes and we described a new etiology for it. The computed tomography is the diagnostic modality of choice, with the aid of other examinations. The treatment comprises conservative measures, minimally invasive approach or most commonly surgery.
胃肠道壁内血肿并不常见，通常位于食管或十二指肠，病因可为特发性或继发性。我们报告一例由一种未公开病因引起的胃壁内血肿的罕见病例，并进行文献复习。
一名老年女性发生急性胸主动脉夹层，随后出现胃壁内血肿，通过内镜检查和计算机断层血管造影确诊。治疗包括血管内主动脉修复和保守治疗。
胃壁内血肿出血的推测机制是终末动脉在穿透进入肌层处撕裂，随后固有肌层与黏膜下层分离。最常提及的危险因素是出血素质/使用抗凝剂，主要病因是创伤和介入性内镜检查后。在诊断检查中，计算机断层扫描是首选方法，通常与内镜检查联合使用。对于这种罕见情况没有标准的治疗方案。因此，治疗可能取决于病因，范围从保守治疗到微创治疗和/或手术治疗。
胃壁内血肿是一种病因多样的罕见疾病，我们描述了一种新的病因。计算机断层扫描是首选的诊断方式，辅助其他检查。治疗包括保守措施、微创方法或最常见的手术治疗。
