Pabani Umesh Kumar, Nirmala Seena Darwin, Visvalingam Subirna, Rasoul Moska, Mohdnazri Shah R
Internal Medicine, Southend University Hospital, Southend-on-Sea, GBR.
Cardiology, Southend University Hospital, Southend-on-Sea, GBR.
Cureus. 2025 Jul 23;17(7):e88563. doi: 10.7759/cureus.88563. eCollection 2025 Jul.
Dual antiplatelet therapy (DAPT) is widely used for secondary prevention following acute coronary syndrome and percutaneous coronary intervention (PCI). Gastrointestinal (GI) bleeding is a known complication of DAPT, typically due to peptic ulcer disease or gastritis. However, oesophageal haematoma is a rare and under-recognised cause of upper gastrointestinal bleeding (UGIB) in this setting. We present a case of a 65-year-old woman who attended an Accident and Emergency Department with typical central chest pain, vomiting, and haematemesis, six months after undergoing PCI and commencing DAPT. Initial investigations raised suspicion for acute coronary syndrome as she presented with chest pain, but coexistent persistent gastrointestinal symptoms, including ongoing haematemesis and vomiting, prompted further evaluation. Oesophagogastroduodenoscopy revealed a large oesophageal haematoma at 20 cm (from incisors) extending to the gastroesophageal junction, approximately 10 cm in length. Contrast-enhanced CT confirmed a non-perforated lesion without mediastinal air. Clopidogrel was discontinued, and the patient was managed conservatively with intravenous proton pump inhibitors (PPIs) for 72 hours. Follow-up endoscopy at two months demonstrated complete resolution of the haematoma. This case illustrates an uncommon but important complication of antiplatelet therapy and reinforces the need for diagnostic vigilance in patients presenting with atypical gastrointestinal symptoms while on DAPT. Individualised management and multidisciplinary input are key to achieving optimal outcomes.
双联抗血小板治疗（DAPT）广泛用于急性冠状动脉综合征和经皮冠状动脉介入治疗（PCI）后的二级预防。胃肠道（GI）出血是DAPT已知的并发症，通常由消化性溃疡病或胃炎引起。然而，在这种情况下，食管血肿是上消化道出血（UGIB）的一种罕见且未被充分认识的原因。我们报告一例65岁女性病例，该患者在接受PCI并开始DAPT六个月后，因典型的中央胸痛、呕吐和呕血前往急诊科就诊。初步检查因患者出现胸痛而怀疑为急性冠状动脉综合征，但同时存在的持续胃肠道症状，包括持续呕血和呕吐，促使进一步评估。食管胃十二指肠镜检查显示在距门齿20 cm处有一个大的食管血肿，延伸至胃食管交界处，长度约为10 cm。增强CT证实为非穿孔性病变，无纵隔积气。停用氯吡格雷，患者接受静脉注射质子泵抑制剂（PPI）保守治疗72小时。两个月后的随访内镜检查显示血肿完全消退。该病例说明了抗血小板治疗一种罕见但重要的并发症，并强调了对接受DAPT治疗且出现非典型胃肠道症状的患者进行诊断警惕的必要性。个体化管理和多学科协作是实现最佳治疗效果的关键。
