Gastric Intramural Hematoma Mimicking a Submucosal Cystic Tumor in an Infant

Abstract

A two-year-and-four-month-old boy presented with a two-day history of high fever of up to 40°C and upper respiratory symptoms and was prescribed cold medication by a local physician. From the fourth day of illness, melena and decreased activity were observed, and on the fifth day, he was emergently transferred to another hospital. Laboratory tests revealed anemia with a Hb level of 10.6 g/dL, and he was admitted with suspected upper gastrointestinal bleeding. Contrast-enhanced computed tomography (CT) demonstrated a 17 mm cystic lesion on the posterior wall of the upper gastric body. Despite fasting and proton pump inhibitor therapy, his Hb level decreased to 8.9 g/dL on the third hospitalization day. Upper gastrointestinal endoscopy revealed a submucosal lesion with erosion at the same site, and he was transferred to our hospital on the ninth hospitalization day for further evaluation and treatment. Surgical treatment was planned under suspicion of a bleeding submucosal cystic gastric tumor. However, contrast-enhanced CT performed on the fourth day after transfer showed complete disappearance of the cystic lesion. Endoscopic ultrasonography on the following day confirmed the resolution of the submucosal lesion and revealed an ulcer scar at the same site. On the basis of these findings, the patient was diagnosed as having an intramural gastric hematoma. Treatment with an H2-receptor antagonist and oral iron supplementation resulted in improvement of anemia and general condition. The patient was discharged on the eighth after transfer. Follow-up contrast-enhanced CT one year later showed no recurrence of the intramural gastric hematoma.