An Extremely Rare Association of Alcohol-Induced, Necrotizing, Acute Pancreatitis and Giant Dissecting Hematoma of the G
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SURGERY
An Extremely Rare Association of Alcohol-Induced, Necrotizing, Acute Pancreatitis and Giant Dissecting Hematoma of the Gastric Wall with Hemorrhagic Shock: a Case Report Francesco Polistina 1
&
Enrico Belluco 1 & Donatello Errante 1 & Mauro Frego 1
Accepted: 4 November 2020 # Springer Nature Switzerland AG 2020
Abstract Intramural gastric-wall hemorrhage is an extremely rare condition associated with acute pancreatitis. To the authors’ knowledge, at present, only four cases have been reported in the international literature, the case reported herein being the fifth. We performed an extensive literature review on the issue and compared our data with those of similar reports. A 69-year-old man was admitted to the emergency department complaining of severe epigastric pain with tenderness and muscle guarding. After initial diagnostic workup, acute pancreatitis associated with intramural gastric mass was diagnosed. Upfront conservative treatment was begun, but the patient worsened, with class 3 hemorrhagic shock appearing. The patient underwent emergent explorative laparotomy that revealed a huge intraparietal gastric hematoma requiring total gastrectomy to control bleeding. Because an intramural gastric-wall hematoma is a very rare condition and usually associated with both primary and acquired coagulation disorders, it requires a high suspicion index for a prompt diagnosis. Small gastric-wall hematomas can be treated conservatively, especially when associated with anticoagulation therapy, but surgery must always be considered for patients who fail conservative or angiographic treatment. Furthermore, surgery may be considered an upfront therapy for emergent cases. Surgery remains the procedure of choice in all cases not responding to conservative therapy and when hemorrhagic shock develops. Keywords Gastric-wall hematoma . Gastrectomy . Acute pancreatitis
Introduction A parietal hematoma of the gastrointestinal tract is an exceedingly rare event, and a gastric parietal hematoma (GPH) is even rarer. An extensive review of the topic in the English literature of the last 40 years yielded fewer than 40 reported cases, of which 24 occurred in a single published review [1]. According to the etiology, more than half of these GPHs were associated with drug-induced coagulopathy caused by warfarin, aspirin or clopidogrel and, more rarely, with congenital coagulation disorders, including hemophilia and von Willebrand disease. The remaining cases were related to abdominal blunt traumas, visceral aneurysms, complications of This article is part of the Topical Collection on Surgery * Francesco Polistina [email protected] 1
Department of Surgery, ULSS 6, Monselice Hospital (PD), Via Albere 32, Monselice, 35042 Padua, Italy
endoscopic procedures, peptic ulcers, and persisting vomiting in Mallory-Weiss syndrome or were considered idiopathic [2]. In the last 20 years, only 4 reported cases have been associated with both acute and chronic pancreatitis [3–6]. Herein, we present the case of a giant hematoma with
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