2021 Volume 63 Issue 11 Pages 2330-2336
A woman in her 80s, who was fed through a gastrostomy tube because of cerebral infarction sequelae, developed two episodes of vomiting after she received enteral nutrition. A back flow of blood components through the gastrostomy tube was observed when the clamp of the tube was released; therefore, she was transferred to our hospital on an emergency basis. Upper gastrointestinal endoscopy revealed multiple submucosal hematomas with air bubbles, which extended from the middle to the lower esophagus. Some hematomas had already ruptured and the remaining were easily ruptured following endoscopic manipulation. The bleeding was venous in origin, and endoscopic hemostasis was not performed. Abdominal computed tomography (CT) performed after endoscopy revealed mild thickening of the esophageal wall and gas in the portal veins. Endoscopy performed the following day revealed rupture of most hematomas with reduction in the number of hematomas. On the third day of hospitalization, the patient resumed enteral nutrition through the gastrostomy tube without complications. CT performed on the fourth day of hospitalization revealed disappearance of gas in the portal veins. Endoscopy performed on the fifth day revealed disappearance of the hematomas, with only partial erosion of the esophageal mucosa. Therefore, the patient was discharged on the sixth day of hospitalization. Endoscopy performed after discharge (on the 19th day of hospitalization.) revealed no abnormal findings in the esophagus. We report a rare case of multiple spontaneous esophageal submucosal hematomas containing air bubbles associated with gas in the portal veins.
