Abstract
A 51-year-old male was admitted because of chest pain. He liked spiced food and had no history of bleeding tendency. He had taken a large amount of pepper sauce two days before the onset, and had been complaining of discomfort in the upper chest since then. On the day before admission, shortly after dinner, during which he had a heated quarrel, he felt a sharp pain in the upper chest and vomited twice. The last vomit contained a small amount of blood. After vomiting the pain extended to the epigastrium and became severer. Endoscopy on admission the next morning revealed a small ulcer in the upper esophagus. And from the distal edge of the ulcer, a submucosal hematoma extended continuously to just above the esophagogastric junction, being gigantic in the distal part. The symptom resolved with only supportive treatment. Although a long belt-like shallow ulcer lesion was formed after breaking down of the hematoma, it was healed by the 21st hospital day without any stricture. A possible mechanism leading to the submucosal hematoma is as follows : pepper sauce could cause damage to the mucosa in the upper esophagus. With additional factors such as the stimuli of eating and drinking, ulceration might be induced, followed by vomiting. Hemorrhage could develop in the submucosal layer, forming a long gigantic hematoma.
