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PTU-139 An Unusual Complication of Myelodysplasia
  1. A K Gabr1
  1. 1South Tyneside NHS Foundation Trust, South Tyneside, UK

Abstract

Introduction Oesophageal haematoma is a rare clinical entity which is part of the spectrum of oesophageal injuries that includes Mallory-Weiss tear and Boerhave’s syndrome. We present a case of oesophageal haematoma as the only complication of myelodysplasia.

Methods Case presentation An 81 year old gentleman presented to the emergency department with sudden onset chest pain. He ate a scone and went to bed. Half an hour later, he developed a sharp, retrosternal pain,radiating to the neck. The pain was worse by breathing and swallowing. His past medical history included myelodysplasia and ischemic heart disease. Physical examination was unremarkable. Laboratory investigations showed platelets count of 59 × 103, D. Dimer of 2746 ng/ml. CT pulmonary angiography didn’t show any pulmonary embolus but obstructed oesophagus,filled with food up to the middle part. Gastroscopy showed large bluish red mass extending between 23 cm and 40 cm in the Oesophageal lumen, originating from the submucosa. The mass didn’t look malignant, therefore, biopsies were not taken. Clinical impression was submucosal oesophageal haematoma. Aspirin was stopped and he was treated conservatively, with liquid diet. Dysphagia improved and he was discharged 4 days later. Complete resolution was shown on follow up CT thorax and gastroscopy 6 weeks later.

Results Discussion The first published report of Oesophageal haemtoma,from Marks and Keat in 1968, described a small mucosal breach as a constant feature. It is a result of haemorrhage within the oesophageal wall, usually in the submucosa and more often in the distal oesophagus as it is least supported by adjacent structures. The pathogenesis is unclear, Criblez and colleagues reviewed 91 patients with submucosal haematoma in literature, Precipitating factors were vomiting in 22% of cases, instrumentation in 17%, haemostasis abnormalities in 21% and spontaneous occurrence in 37%.Acute chest pain is a common presentation that should be differentiated from other causes as myocardial infarction. The typical triad of chest pain, hematemesis and dysphagia occurred only in one third of patients.CT typically, shows symmetric or asymmetric oesophageal thickening with concentric or eccentric oesophageal mass with well-defined borders. Gastroscopy is the diagnostic test of choice. Most cases resolve spontaneously within 1–3 weeks with conservative approach. Surgery is only indicated in complicated cases. Angiography is usually considered when endoscopic therapy failed or when surgery is risky.

Conclusion Diagnosis of Oesophageal haematoma can be achieved by interpreting symptoms in conjunction with imaging and endoscopy findings at presentation and follow up. Porgnosis is favourable, as it usually resolves with conservative management.

Disclosure of Interest None Declared

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