PDF(Pubmed)
Abstract：
BACKGROUND: Gastric intramural hematoma is a rare disease. Here we report a case of spontaneous isolated gastric intramural hematoma combined with spontaneous superior mesenteric artery intermural hematoma.
METHODS: A 75-years-old man was admitted to our department with complaints of abdominal pain. He underwent a whole abdominal computed tomography (CT) scan in the emergency department, which showed extensive thickening of the gastric wall in the gastric body and sinus region with enlarged surrounding lymph nodes, localized thickening of the intestinal wall in the transverse colon, localized indistinct demarcation between the stomach and transverse colon, and a small amount of fluid accumulation in the abdominal cavity. Immediately afterwards, he was admitted to our department, and then we arranged a computed tomography with intravenously administered contrast agent showed a spontaneous isolated gastric intramural hematoma combined with spontaneous superior mesenteric artery intermural hematoma. Therefore, we treated him with anticoagulation and conservative observation. During his stay in the hospital, he was given low-molecular heparin by subcutaneous injection for anticoagulation therapy, and after discharge, he was given oral anticoagulation therapy with rivaroxaban. At the follow-up of more than 4 months, most of the intramural hematoma was absorbed and became significantly smaller, and the intermural hematoma of the superior mesenteric artery was basically absorbed, which also confirmed that the intramural mass was an intramural hematoma.
CONCLUSIONS: A gastric intramural hematoma should be considered, when an intra-abdominal mass was found to be attached to the gastric wall. Proper recognition of gastric intramural hematoma can reduce the misdiagnosis rate of confusion with gastric cancer.
METHODS: A 75-years-old man was admitted to our department with complaints of abdominal pain. He underwent a whole abdominal computed tomography (CT) scan in the emergency department, which showed extensive thickening of the gastric wall in the gastric body and sinus region with enlarged surrounding lymph nodes, localized thickening of the intestinal wall in the transverse colon, localized indistinct demarcation between the stomach and transverse colon, and a small amount of fluid accumulation in the abdominal cavity. Immediately afterwards, he was admitted to our department, and then we arranged a computed tomography with intravenously administered contrast agent showed a spontaneous isolated gastric intramural hematoma combined with spontaneous superior mesenteric artery intermural hematoma. Therefore, we treated him with anticoagulation and conservative observation. During his stay in the hospital, he was given low-molecular heparin by subcutaneous injection for anticoagulation therapy, and after discharge, he was given oral anticoagulation therapy with rivaroxaban. At the follow-up of more than 4 months, most of the intramural hematoma was absorbed and became significantly smaller, and the intermural hematoma of the superior mesenteric artery was basically absorbed, which also confirmed that the intramural mass was an intramural hematoma.
CONCLUSIONS: A gastric intramural hematoma should be considered, when an intra-abdominal mass was found to be attached to the gastric wall. Proper recognition of gastric intramural hematoma can reduce the misdiagnosis rate of confusion with gastric cancer.
摘要：
背景：胃壁内血肿是一种罕见的疾病。本文报道一例自发性孤立性胃壁间血肿合并自发性肠系膜上动脉壁间血肿。
方法：一名75岁的男子因腹痛而入院。他在急诊科接受了整个腹部计算机断层扫描（CT）扫描，显示胃体和窦区胃壁广泛增厚，周围淋巴结肿大，横结肠肠壁局部增厚，胃和横结肠之间的局部模糊分界，腹腔内有少量液体积聚.紧接着,他被我们部门录取了,然后我们安排了静脉给药造影剂的计算机断层扫描显示自发性孤立性胃壁间血肿合并自发性肠系膜上动脉壁间血肿。因此,我们对他进行了抗凝治疗和保守观察。在他住院期间,皮下注射低分子肝素抗凝治疗,出院后，他接受了利伐沙班口服抗凝治疗。在4个多月的随访中，大部分壁内血肿被吸收并变得明显变小，肠系膜上动脉壁间血肿基本被吸收,这也证实了壁内肿块是壁内血肿。
结论：应考虑胃壁内血肿，当发现腹内肿块附着在胃壁上时。正确认识胃壁内血肿可降低与胃癌混淆的误诊率。
方法：一名75岁的男子因腹痛而入院。他在急诊科接受了整个腹部计算机断层扫描（CT）扫描，显示胃体和窦区胃壁广泛增厚，周围淋巴结肿大，横结肠肠壁局部增厚，胃和横结肠之间的局部模糊分界，腹腔内有少量液体积聚.紧接着,他被我们部门录取了,然后我们安排了静脉给药造影剂的计算机断层扫描显示自发性孤立性胃壁间血肿合并自发性肠系膜上动脉壁间血肿。因此,我们对他进行了抗凝治疗和保守观察。在他住院期间,皮下注射低分子肝素抗凝治疗,出院后，他接受了利伐沙班口服抗凝治疗。在4个多月的随访中，大部分壁内血肿被吸收并变得明显变小，肠系膜上动脉壁间血肿基本被吸收,这也证实了壁内肿块是壁内血肿。
结论：应考虑胃壁内血肿，当发现腹内肿块附着在胃壁上时。正确认识胃壁内血肿可降低与胃癌混淆的误诊率。
