A Case of Gastric Intramural Hematoma after an Epinephrine Injection for Gastric Ulcer Bleeding in a Patient Medicated with Aspirin

아스피린 복용중인 위궤양 출혈 환자에서 에피네프린 주입술후 발생한 위벽 내 혈종 1예

  • Noh, Hyung-Min (Department of Internal Medicine, Gwangju Veterans Hospital) ;
  • Seo, Young-Ho (Department of Internal Medicine, Gwangju Veterans Hospital) ;
  • Lee, Nam-Hun (Department of Internal Medicine, Gwangju Veterans Hospital) ;
  • Lee, Bong-Kyu (Department of Internal Medicine, Gwangju Veterans Hospital) ;
  • Park, Sang-Hyun (Department of Internal Medicine, Gwangju Veterans Hospital) ;
  • Kim, Yeon-Hwa (Department of Internal Medicine, Gwangju Veterans Hospital) ;
  • Lim, Chur-Hoan (Department of Internal Medicine, Gwangju Veterans Hospital) ;
  • Song, Sung-Hwan (Department of General Surgery, Gwangju Veterans Hospital)
  • Published : 2011.07.30

Abstract

An intramural hematoma of the stomach usually results from trauma. Gastric intramural hematomas may also occur in patients with bleeding disorders who are receiving anticoagulation therapy or after an endoscopic procedure. Here, we describe a case of a gastric intramural hematoma after endoscopic hemostasis for gastric ulcer bleeding in a patient medicated with aspirin.

위장관 내의 혈종은 드문 질환이며, 이 중 위벽 내에 발생하는 혈종은 극히 드문 질환이다. 주로 복부 둔상에 의하거나 혈액응고 장애가 있는 환자에서 발생하지만, 최근 항혈소판제와 항응고제와 같은 약물을 복용하는 환자 및 내시경 시술의 증가로 인하여 이와 같은 환자가 증가하고 있다. 대부분의 위벽 내혈종의 경우 보전적인 치료로 호전되지만 본 증례와 같이 반복적인 내시경 지혈술 후 발생하여 보존적인 치료에도 호전이 없을 경우 혈관 조영술을 통한 치료나 수술 치료도 생각해 볼 수있다. 저자들은 아스피린을 복용중인 환자에서 반복적인 내시경 지혈술 후 발생한 위벽 내 혈종을 수술로 치료하여 호전된 증례를 보고한다.

Keywords

References

  1. Jones WR, Hardin WJ, Davis JT, Hardy JD. Intramural hematoma of the duodenum: a review of the literature and case report. Ann Surg 1971;173:534-544. https://doi.org/10.1097/00000658-197104000-00009
  2. Dhawan V, Mohamed A, Fedorak RN. Gastric intramural hematoma: a case report and literature review. Can J Gastroenterol 2009;23:19-22.
  3. Rohrer B, Schreiner J, Lehnert P, Waldner H, Heldwein W. Gastrointestinal intramural hematoma, a complication of endoscopic injection methods for bleeding peptic ulcers: a case series. Endoscopy 1994;26:617-621. https://doi.org/10.1055/s-2007-1009050
  4. Lee SY, Jo SK, Park SM, et al. Intramural duodenal hematoma complicated with pancreatitis after endoscopic hemostasis in a chronic renal failure patient with maintenance hemodialysis. Korean J Nephrol 2002;21:675-679.
  5. Ahn YY, Ann SH, Yi JE, et al. A case of intramural duodenal hematoma after the use of the endoscopic epinephrine injection method for duodenal ulcer bleeding in a chronic renal failure patient undergoing maintenance hemodialysis. Korean J Gastrointest Endosc 2009;38:94-97.
  6. Cheong HC, Kim TH, Chung JS, et al. An intramural gastric hematoma after epinephrine injection for gastric ulcer bleeding in patient with liver cirrhosis. Korean J Gastrointest Endosc 2010;40:366-369.
  7. Buffoli F, Graffeo M, Nicosia F, et al. Peptic ulcer bleeding: comparison of two hemostatic procedures. Am J Gastroenterol 2001;96:89-94.
  8. Elliott S, Bruce J. Submucosal gastric hematoma: a case report and review of the literature. Br J Radiol 1987;60:1132-1135. https://doi.org/10.1259/0007-1285-60-719-1132
  9. Guzman C, Bousvaros A, Buonomo C, Nurko S. Intraduodenal hematoma complicating intestinal biopsy: case reports and review of the literature. Am J Gastroenterol 1998;93:2547-2550.
  10. Balthazar EJ, Einhorn R. Intramural gastrointestinal hemorrhage. Clinical and radiographic manifestations. Gastrointest Radiol 1976;1:229-239. https://doi.org/10.1007/BF02256371
  11. Morimoto K, Hashimoto T, Choi S, et al. Ultrasonographic evaluation of intramural gastric and duodenal hematoma in hemophiliacs. J Clin Ultrasound 1988;16:108-113. https://doi.org/10.1002/jcu.1870160208
  12. Plojoux O, Hauser H, Wettstein P. Computed tomography of intramural hematoma of the small intestine: a report of 3 cases. Radiology 1982;144:599-561.
  13. Imaizumi H, Mitsuhashi T, Hirata M, et al. A giant intramural gastric hematoma successfully treated by transcatheter arterial embolization. Intern Med 2000;39:231-234. https://doi.org/10.2169/internalmedicine.39.231
  14. Han SJ, Tsai CC, Mo LR, Tseng LJ, Yau MP. Laparoscopic finding and imaging of the iatrogenic duodenal intramural hematoma. Hepatogastroenterology 1997;44:139-142.