Beyond Peptic Ulcers: Oesophageal Haematoma, an Under-Recognised Cause of Gastrointestinal (GI) Bleeding on Dual Antiplatelet Therapy (DAPT).

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.