Analysis Of Esophageal Hematoma In Main Manifestations Of Upper Gastrointestinal Hemorrhage

BackgroundAlong with the improvement of living standard and the accelerating rhythm of life inChina, the incidence of gastrointestinal diseases is higher and higher, and as agastrointestinal disease, the incidence of upper gastrointestinal bleeding is increasing yearby year. Upper gastrointestinal bleeding (upper gastrointestinal hemorrhage, UGIH) refers tothe bleeding caused by alimentary canal diseases of esophagus, stomach, duodenum,pancreatic duct and bile duct, superior segment of jejunum above Treitz ligament, andincluding the bleeding caused by diseases near the postoperative anastomosis ofgastrojejunostomy, which clinical manifestations are hematemesis and melena, severe casescan be life-threatening, so it is a common clinical severe acute disease. Upper gastrointestinal bleeding is mainly divided into two categories: Variceal upper gastrointestinalbleeding (VGB) and Non-variceal upper gastrointestinal bleeding (UGB). Now theproportion of the use of antiplatelet drugs to prevent cardiovascular disease andnon-steroidal anti-inflammatory drug to treat related diseases is increasing, thus the cause ofupper gastrointestinal bleeding has been changed, but peptic ulcer, acute gastric mucosallesion, upper gastrointestinal malignant tumor, Mallory-Weiss syndrome, reflux esophagitisand esophageal injury are still the main cause of non-variceal upper gastrointestinalbleeding (UGB). But due to the advance of diagnostic methods, the mortality of uppergastrointestinal bleeding has declined. The current treatments are internal medicineconservative treatment, endoscopic treatment, DSA (digital subtraction angiography)diagnosis and interventional therapy and surgery. The proportion of esophageal disease inthe share of upper gastrointestinal bleeding reason is low. Esophageal hematoma rarelycauses upper gastrointestinal hemorrhage in clinical cases. The clinical manifestation,auxiliary examination, diagnosis, differential diagnosis, treatment and prognosis ofesophageal hematoma reported are rare in China and abroad. Although it is a rare disease, it is a clinical severe acute digestive disease. So it should be highly valued.ObjectiveIn this study we analyzed the etiology, pathogenesis, clinical manifestations, laboratoryand other examination, diagnosis and differential diagnosis, and treatment of esophagealhematoma by three cases reports of esophageal hematoma, to further improve the diagnosisrate.MethodsWithin the department of gastroenterology of PLA88hospital, three cases wereselected for analysis from January2002to December2012. They were on admission forupper gastrointestinal bleeding and were diagnosed as esophageal hematoma by electronicgastroscopy.ResultManifestations under gastroscope of case one:28cm away from the incisors there wasa bleeding blister that its surface was purple,28to38cm away from the incisors, a largehematoma can be seen on esophageal posterior wall. Manifestations under gastroscope ofcase two:22cm and33cm away from the incisors respectively, there was a hematoma withesophageal mucosal erosion and shallow ulcer, fresh blood can be seen in the esophageallumen. Manifestations under gastroscope of case three:20cm from incisors, a hematomaand extensive ulceration of the esophageal mucosa can be seen, necrotic tissue and bloodclots coated on the surface, and a slight depression ulcers at gastric angle was found. Allpatients were diagnosed by esophageal hematoma after the inspection. All patients had clearincentive histories of esophageal foreign body before the onset and clinical manifestationsof haematemesis, chest burning sensation and chest pain and other symptoms. All thesepatients were in the elderly, one of them was with a history of hypertension and coronaryheart disease. They finally recovered by fasting treatment, acid suppression, hemostasis,protecting the esophagus and gastric mucosa, maintaining water-electrolyte balance andsupportive treatment. The course of diseases is2to3weeks.ConclusionEsophageal hematoma is a rare disease in clinic. Its clinical manifestations are complex,which easily lead to misdiagnosed, especially in old people with underlying diseases. It isvery difficult to get a definite diagnosis. In addition, we should pay attention to theidentification with acute myocardial infarction, dissecting aneurysm of aorta, perforation ofesophagus, esophageal cancer, pulmonary embolism，esophageal varices bleeding, pepticulce, Mallory-Weiss syndrome, etc. Once getting the final diagnosis, the patients recover by fasting treatment, acid suppression, hemostasis, protecting the esophagus and gastricmucosa, maintaining water-electrolyte balance and supportive treatment.