2021 Volume 63 Issue 8 Pages 1489-1494
A few studies have reported spontaneous submucosal hematoma of the esophagus, but our review of the literature revealed that formation of a submucosal hematoma following endoscopic retrograde cholangiopancreatography (ERCP) is very rare. We report a case of submucosal hematoma of the esophagus following ERCP in a patient with pemphigus.
A 68-year-old man was admitted to our hospital for treatment of pemphigus, and a consultation with our department was requested for examination of liver damage. The patient underwent ERCP and biliary drainage for biliary stricture. When removing the duodenal endoscope, a submucosal hematoma extending along the long axis was found in the middle and lower esophagus. Upper gastrointestinal endoscopy that had been performed before ERCP for screening showed no esophageal disease associated with pemphigus. Seven days after ERCP, endoscopy showed improvement of the esophageal submucosal hematoma with a superficial ulcer and mucosal bridge. After conservative treatment, the patientʼs subsequent clinical course was uneventful.
Patients at high risk for bleeding and patients with pemphigus are especially prone to complications from ERCP. Therefore, we should perform the endoscopic procedure in these patients more carefully and protectively to reduce mechanical stimulation.
