Abstract
Objective: We report a rare case of spontaneous esophageal submucosal hematoma after coil embolization for unruptured intracranial aneurysm.
Case presentation: A 70-year-old woman presented with an unruptured paraclinoid internal carotid aneurysm of 7 mm in diameter. We prescribed two anti-platelet agents (aspirin and clopidogrel) for her before the embolization. With the patient under general anesthesia, we completely embolized the wide-neck aneurysm with platinum coils using a balloon remodeling technique. Intraoperative administration of intravenous heparin had prolonged her activated clotting time by more than 2.5 times that of the preoperative value. Following extubation, the patient vomited repeatedly, and felt strong pain in her chest and back. On the basis of contrast-enhanced computed tomography of the chest and abdomen, we diagnosed her as having a spontaneous esophageal submucosal hematoma. Conservative therapy led to good healing as indicated by follow-up upper gastrointestinal endoscopy.
Conclusion: Spontaneous esophageal submucosal hematoma is a rare disease. In the present case, both incidental overdose of heparin during coil embolization and repeated vomiting after extubation appeared to be the main causes of the esophageal submucosal hematoma. The possibility of this complication should be kept in mind to ensure that the anti-thrombotic therapy given in endovascular neurosurgery is appropriate.
