PMC5804650_01
Upper gastrointestinal endoscopy images immediately after hematemesis. a A longitudinal extension of reddish or wine-colored mucosal thickening (asterisk), obstructing the esophagus, is seen from the midesophagus to the esophagogastric junction. b The submucosal hematoma (two asterisks) is displacing the esophageal mucosa (asterisk) toward the gastric cavity at the esophagogastric junction. A part of the displaced mucosa has a laceration with bleeding
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Fig1
An upper gastrointestinal endoscope was inserted immediately to identify the bleeding point and achieve hemostasis, which showed submucosal thickening extending from the midesophagus to the esophagogastric junction, which was due to the submucosal hematoma (Fig. 1a: endoscopic image). At the esophagogastric junction, the esophageal mucosa was being displaced into the gastric cavity by the submucosal hematoma (Fig. 1b: endoscopic image).
Cervical and thoracic CT images after insertion of Sengstaken-Blakemore tube. a Sagittal section: the soft tissue shadow is filled and dilatation can be seen in the posterior wall over the entire length of the esophagus (red arrows), ventrally displacing the lumen. b Cross-section: the cervical esophagus is dilated, displacing the trachea toward the left side
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Fig2
A plain computed tomography (CT) was performed to assess the extent of the hematoma, which showed dilatation of the entire esophagus and the soft tissue shadow filled on the dorsal side that was ventrally displacing the lumen (Fig. 2a: CT sagittal section).
Upper gastrointestinal endoscopy image 7 days after surgery. The esophageal submucosal had almost disappeared, and the slough had adhered to the mucosal laceration at the esophagogastric junction
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Fig3
Upper gastrointestinal endoscopy performed 7 days after surgery showed that the esophageal submucosal hematoma had almost disappeared and the slough had adhered to the mucosal laceration at the esophagogastric junction (Fig. 3).