Spontaneous gastric hematoma as a rare cause of acute abdomen: A case report

Abstract

Background: Spontaneous gastric hematoma is an exceedingly rare condition characterized by the accumulation of blood within the gastric wall without any apparent iatrogenic or traumatic cause. Coagulopathies are the most frequent cause of gastric hematomas. However, other causes include amyloidosis, pancreatitis, visceral vascular aneurysms, endoscopy complications and others. The pathophysiology of spontaneous gastric hematoma is not completely understood. However, it is postulated that it is caused by disruption of submucosal vessels that leads to dissection of the muscularis layer and formation of false lumen. The rarity of this condition increases the challenge of diagnosis, and there is no standard treatment protocol.

Case summary: We present the case of a spontaneous gastric hematoma in a 22-year-old male. He presented to our emergency department complaining of pain in the left flank area lasting for 2 wk. There was no history of trauma, anticoagulant medications or endoscopy procedures. His hemoglobin and hematocrit levels were slightly lower than normal. Multi-slice computed tomography, ultrasound and endoscopy confirmed a gastric intramural hematoma. We recommended conservative treatment because there was no hemodynamic instability nor significant bleeding. The patient responded well, and there were no unexpected events. At the 3-mo follow-up, the ultrasound examination revealed complete regression of the hematoma.

Conclusion: After reviewing the literature and our experience, we recommend that more of these cases should be treated conservatively. The tendency to treat these cases with potentially burdensome procedures such as total or subtotal gastrectomy should be significantly reduced.

Keywords: Acute abdomen; Case report; Conservative treatment; Intramural hematoma; Spontaneous; Stomach.

Figure 1

Imaging and endoscopic examination of gastric intramural hematoma. A: Contrast enhanced multi-slice computed tomography (MSCT) coronary view of the gastric intramural hematoma (GIH); B: MSCT sagittal view of GIH; C: MSCT transversal view of GIH; D: Endoscopic view of GIH (white arrow indicates the bulging of the greater curvature mucosa).