Causes and Management of Esophageal Hematoma: A Review

Intramural hematoma of the esophagus (IHE) or dissecting intramural hematoma is a relatively unusual complication of acute mucosal and submucosal lesions that results in a blood accumulation between the layers of the esophagus. Esophageal hematoma is a rare condition that can develop spontaneously or as a result of trauma, poisoning, or medical intervention. Mallory-Weiss syndrome, Boerhaave syndrome, and IHE are all forms of acute mucosal damage of the esophagus, with IHE being the rarest of the three. In general, esophageal traumatic damage, including traumatic penetration and perforation, is uncommon, making IHE incidence and prevalence difficult to measure. Although most esophageal hematomas are asymptomatic, they can cause significant chest discomfort, dysphagia, and hematemesis. Esophageal hematomas should be distinguished from Mallory-Weiss tear and Boorhaave's syndrome, which they may closely resemble in such cases. Moreover, cardiovascular and respiratory diseases should be ruled out, therefore further tests such as an electrocardiogram, chest X-ray, and laboratory testing can be useful. The majority of cases resolve with conservative treatments, with symptoms disappearing in 1-2 weeks. NPO, IV fluids, acid suppression, and treatment of coagulopathy are all conservative procedures. This review aims to summarize current evidence on etiology, epidemiology, diagnosis and management of esophageal hematoma.