Large gastric intramural hematoma: unusual complication of endoscopic submucosal dissection

Abstract

A 72-year-old woman was referred for evaluation of a gastric subepithelial tumor ([Fig. 1]). The patient had no remarkable medical history. Laboratory evaluation revealed normal platelet count and coagulation profiles. Following discussion with the patient, diagnostic endoscopic submucosal dissection (ESD) was carried out. The procedure was initiated with a submucosal saline injection using a 23-G injection needle (NM-200L-0423, Olympus, Tokyo, Japan) to raise the lesion. Soon after the injection, the patient experienced epigastric pain and the formation of a hematoma, which progressively enlarged over the injection site ([Fig. 2]). The patient was admitted and received conservative treatment including blood transfusion, fasting, a proton pump inhibitor (esomeprazole), and pain control using tramadol. Follow-up endoscopic examination on day 6 revealed an enormous ulcer in the area of the injection site ([Fig. 3]). Oral feeding was recommenced and the patient was discharged. Follow-up endoscopy after 3 months revealed complete healing of the ulcer with some scarring ([Fig. 4]).