Esophageal Hematoma Treatment & Management

Updated: Dec 09, 2016
  • Author: Jennifer Lynn Bonheur, MD; Chief Editor: Philip O Katz, MD, FACP, FACG  more...
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Treatment

Medical Care

For spontaneous intramural hematoma, conservative therapy leads to an excellent prognosis. Esophageal hematomas generally resolve within 2-3 weeks with no long-term sequelae. [21]  Note the following:

  • Nothing by mouth (NPO) for the first several days. Oral intake should be reintroduced gradually. A soft diet may be started in a stable patient on days 4-6. Parenteral feeding is generally not required, as most patients are able to swallow within a few days.

  • Provide intravenous fluids while the patient is NPO and transfusion of blood if needed. Acid suppression should also be considered to reduce the risk of esophageal ulceration. Antiemetics are indicated as needed.

  • Correction of any coagulation abnormalities is indicated.

  • Occasionally, extensive esophageal hematomas have been treated by sclerosant injections. Because this entity is so rare, a clear indication for this therapeutic approach has not yet been established. Complications during endoscopic sclerotherapy include rupture of the intramural hematoma.

Follow-up care after the acute event has resolved with either a barium swallow or endoscopy is necessary to rule out any additional esophageal disease not seen on the initial evaluation. This can be done prior to discharge or can be arranged to be done on an outpatient basis.

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Surgical Care

Surgery is only indicated in patients with massive ongoing hematemesis. This occurred in 19% of patients, as reported in a literature review of 31 patients with esophageal hematoma.

Via a right thoracotomy, an esophagotomy may expose the bleeding tissue, which is then oversewn.

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Consultations

Consultations with specialists in cardiology, gastroenterology, and thoracic surgery may be needed.

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Complications

Full-thickness perforations of the esophageal wall have been reported during endoscopy of an esophageal hematoma.

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