A Rare Case of Gastric Intramural Hematoma Secondary to Hemorrhagic Pancreatitis

Abstract

Gastric intramural hematoma (GIH) is a contained hemorrhage located within the layers that comprise the wall of the stomach. It is a rare condition that has a variety of etiologies. Pancreatitis-induced GIH is an even rarer phenomenon, with only a handful of documented cases in the medical literature. In the current case, a patient presented with chronic abdominal pain for the past two months, with an acute worsening of symptoms. CT imaging confirmed a large, stable GIH with concomitant pancreatitis, likely alcohol-induced. Diagnostic laparoscopy was performed in response to worsening hemodynamic status, which confirmed hemorrhagic pancreatitis as the likely cause of the GIH formation. Jackson-Pratt (JP) drains were placed, and the patient was subsequently discharged. The patient returned one month later with an acute exacerbation of pancreatitis; however, interval improvement of the GIH was observed. The patient was transferred to outpatient care for continued conservative treatment without any further return visits.

Keywords: conservative treatment; diagnostic laparoscopy; gastric intramural hematoma; gastrointestinal hemorrhage; hemoperitoneum; lipase; pancreatitis.

Figure 1. CT angiogram revealing a GIH

A, B, C: Axial, coronal, and sagittal views of the initial presentation of the GIH (red arrows). The GIH was imparting a mass effect on the stomach and surrounding structures, compressing the gastric lumen (orange arrows). GIH: gastric intramural hematoma

Figure 2. CT of the abdomen and pelvis with IV and oral contrast revealing the GIH

A, B, C: Axial, coronal, and sagittal views with oral contrast better illustrate the margins of the GIH (red arrows). Compression of the gastric lumen (orange arrows) due to mass effect from the GIH is better observed. GIH: gastric intramural hematoma

Figure 3. CT of the abdomen and pelvis with oral contrast one month after the initial discharge

A, B, C: Axial, coronal, and sagittal views showing interval improvement and a decrease in the overall size of the GIH (red arrows). Due to the reduced size of the GIH, the lumen of the stomach (orange arrows) is less compressed. GIH: gastric intramural hematoma