Reactions 1704, p54 - 2 Jun 2018 Oesophageal haematoma: 2 case reports In a case report, two elderly women were described, of whom, an 84-year-old woman developed oesophageal haematoma during treatment with aspirin and warfarin, while a 75-year-old woman developed oesophageal haematoma during treatment with aspirin and clopidogrel [dosages, routes and durations of treatments to reactions onsets not stated]. Patient 1: The 84-year-old woman, who had a history of coronary artery disease and atrial fibrillation, was receiving treatment with aspirin and warfarin. She presented to the emergency room with haemoptysis and throat pain after an episode of chocking, which was relieved by Heimlich maneuver. She was discharged after her symptoms subsided. However, she continued to experience haemoptysis and progressive fatigue over the next two days. Therefore, she returned to the emergency room. A CT scan of the neck showed a large soft tissue defect of the proximal oesophagus. The woman’s treatment with aspirin and warfarin was discontinued and she was made nil per os. An oesophagogastroduodenoscopy revealed an oesophageal haematoma extending 25cm distally from the hypopharynx occluding 75% of the oesophageal lumen. The oesophageal haematoma was attributed to anticoagulant therapy including aspirin and warfarin and oesophageal barotrauma due to choking. A percutaneous endoscopic gastrostomy (PEG) tube was placed on post-injury day 7. On post-injury day 45, a CT scan showed complete resolution of the haematoma. On post- injury day 52, her PEG tube was removed, and anticoagulation with unspecified medication was resumed on post-injury day 80. Patient 2: The 75-year-old woman, who had a history of coronary artery disease status post-stenting, was receiving treatment with aspirin and clopidogrel. She was hospitalised due to Bell’s palsy. The next morning, she had vomiting with retching, which was immediately followed by severe throat pain, mid-back pain and haematemesis. A CT scan revealed a large oesophageal soft tissue mass. An oesophagogastroduodenoscopy showed an oesophageal haematoma, which extended from the cricopharyngeus to the oesophagogastric junction. The oesophageal haematoma was attributed to anticoagulant therapy including aspirin and clopidogrel and oesophageal barotrauma due to vomiting with retching. A percutaneous endoscopic gastrostomy (PEG) tube was inserted. The woman was made nil per os and started on treatment with pantoprazole and total parenteral neutrition. On post-injury day 7, she was started on tube feeds. On post- injury day 26, a repeat oesophagogastroduodenoscopy revealed no evidence of the oesophageal haematoma. Then, she was started on a soft texture diet. On post-injury day 36, a CT scan of the chest showed complete resolution of the haematoma. On post-injury day 39, the PEG tube was removed. Author comment: "[Oesophageal haematoma] is a rare condition that is seen more commonly in women and the elderly." "Risk factors include anticoagulation therapy." Vossler JD, et al. Esophageal hematoma following acute esophageal barotrauma. American Surgeon 83: E213-E215, No. 6, Jun 2017 - USA 803323917 0114-9954/18/1704-0001/$14.95 Adis © 2018 Springer International Publishing AG. All rights reserved Reactions 2 Jun 2018 No. 1704
Reactions Weekly – Springer Journals
Published: Jun 2, 2018
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