A Case of Gastric Intramural Hematoma Caused by Anisakis Infection

Abstract

A sixty-year-old lady admitted complaining of epigastric pain and hematemesis. On admission, esophagogastroduodenoscopic examination revealed ruptured intramural hematoma on the antrum of stomach. Eight days later, follow-up EGD showed improving ruptured intramural hematoma and one anisakis larva. Therefore, the gastric intramural hematoma was considered to be caused by anisakis infection. She recovered after ten days of conservative treatment.

Figure 1

(a) Abdominal computed tomography scan showing about 8 × 3 cm nonenhancing mass (50∼60 Hounsfield unit) in the stomach antrum and lower body, suggesting submucosal hematoma. (b) Gastroscopy showing ruptured intramural hematoma on the anterior wall of antrum and low body. (c) Gastroscopy showing ruptured mucosa and hematoma in inside the mucosa wall.

Figure 2

(a) Significant decreased size of hematoma in the stomach antrum and lower body compared with previous computed tomography. No visible active bleeding in stomach is observed. (b) Gastroscopy showing active ulcer on the anterior wall of the antrum and low body.

Figure 3

(a) Gastroscopy showing whitish thread-like worm on gastroesophageal junction. (b) Gastroscopic finding: the whitish thread-like worm is being removed by using a biopsy forcep. (c) Gross finding showing 2 cm whitish thread-like worm, identified as anisakis larva.