Esophageal submucosal hematoma developed after endovascular surgery for unruptured cerebral aneurysm under general anesthesia: a case report

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Abstract

Background

Esophageal submucosal hematoma is a rare complication after endovascular surgery. We report a case of an esophageal submucosal hematoma which may have been caused by rigorous cough during extubation.

Case presentation

A 75-year-old woman underwent endovascular treatment for unruptured cerebral aneurysm under general anesthesia. The patient received aspirin and clopidogrel before surgery and heparin during surgery. Activated clotting time was 316 s at the end of surgery. Protamine was not administered and continuous infusion of argatroban was started after surgery. She had a rigorous cough during removal of the tracheal tube and reported retrosternal discomfort postoperatively. She developed hemorrhagic shock after massive hematemesis. A diagnosis of esophageal submucosal hematoma was made by endoscopic examination and computed tomography. Hemostasis was achieved by compression with a Sengstaken-Blakemore tube and endoscopic cauterization. Blood pressure was recovered by blood transfusion. Endoscopic examination performed 7 days after surgery showed that esophageal submucosal hematoma had almost disappeared and slough had adhered to the mucosal laceration. The patient showed good recovery and was discharged 21 days after surgery.

Conclusions

Careful extubation and postoperative observation are required in patients receiving antiplatelet and anticoagulant therapy.

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Most cited references 10

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Prevention and treatment of thromboembolic and ischemic complications associated with endovascular procedures: Part II--Clinical aspects and recommendations.

M. Sharma, W Luft, Donald L. Hopkins … (2000)

We reviewed the incidence, risk factors, and clinical features of thromboembolic and ischemic events associated with diagnostic cerebral angiography, endovascular treatment of aneurysms using coils or balloons, angioplasty and stent placement to treat extracranial carotid artery stenosis, and embolization of arteriovenous malformations using glue or other embolic agents. We performed a cumulative analysis to determine the frequency and characteristics of these events and a subset analysis (whenever possible) to determine the benefits of various strategies for complication avoidance. Of the 1,547 patients who underwent Guglielmi detachable coil treatment, thromboembolic events were observed for 127 (8.2%), consisting of asymptomatic events for 12 patients, transient ischemic attacks for 29, and strokes for 86. The outcomes for the 86 patients with strokes were categorized as full recovery for 15, good recovery for 27, partial recovery for 19, no recovery for 11, death for 12, and undetermined outcome for 2. Of the 834 patients who underwent carotid angioplasty and stent placement, thromboembolic events were observed for 73 (8.8%), consisting of transient ischemic attacks for 26 patients and strokes for 47. The outcomes for the patients with strokes were categorized as full recovery for 20, good recovery for 15, partial recovery for 6, no recovery for 2, and death for 4. High rates of thromboembolic events were also observed with balloon occlusion of aneurysms (11%) or parent arteries (19%) and carotid angioplasty alone (5.9%). Arteriovenous malformation embolization was associated with an ischemic event/procedure rate of 9.4%. High rates of thromboembolic and ischemic complications, with subsequent morbidity and death, are associated with most endovascular procedures. Further research and the formulation of standard preventive guidelines may help to reduce these risks and improve the overall success of these procedures.

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Effect of antiplatelet therapy on thromboembolic complications of elective coil embolization of cerebral aneurysms.

N K Yamada, D T Cross, T Pilgram … (2007)

Thromboembolic events are the most common complications of elective coil embolization of cerebral aneurysms. Administration of oral clopidogrel and/or aspirin could lower the thromboembolic complication rate. Records over a 10-year period were reviewed in a retrospective cohort study. For 369 consecutive elective coil embolization procedures, 25 patients received no antiplatelet drugs, 86 received antiplatelet drugs only after embolization, and 258 received antiplatelet drugs before and after embolization. Symptomatic thromboembolic complications (transient ischemic attack or stroke within 60 days) occurred in 4 (16%) of 25 when no antiplatelet drugs were given, in 2 (2.3%) of 86 when antiplatelet drugs were administered only after embolization, and in 5 (1.9%) of 258 when antiplatelet drugs were administered before and after embolization. The lower symptomatic thromboembolic complication rate in the patients who received any antiplatelet therapy was statistically significant (P = .004). Clots were visible intraprocedurally in 5 (4.5%) of 111 when no antiplatelet drugs were administered before procedures and in 4 (1.6%) of 258 when they were (P value not significant). None of the 9 was symptomatic postprocedurally, but 7 were lysed or mechanically disrupted. Extracerebral hemorrhagic complications occurred in 0 (0%) of 25 when no antiplatelet drugs were given and in 11 (3.2%) of 344 when they were (P value not significant). Oral clopidogrel and/or aspirin significantly lowered the symptomatic thromboembolic complication rate of elective coil embolization of unruptured cerebral aneurysms. There were trends toward a lower rate of intraprocedural clot formation in patients given antiplatelet drugs before procedures and a higher hemorrhagic complication rate in patients given antiplatelet drugs. Benefits of antiplatelet therapy appear to outweigh risks.

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Recurrent massive bleeding due to dissecting intramural hematoma of the esophagus: treatment with therapeutic angiography.

Young Hwangbo, Christine H J Kim, Seok Dong … (2009)

Spontaneous or traumatic intramural bleeding of the esophagus, which is often associated with overlying mucosal dissection, constitutes a rare spectrum of esophageal injury called dissecting intramural hematoma of the esophagus (DIHE). Chest pain, swallowing difficulty, and minor hematemesis are common, which resolve spontaneously in most cases. This case report describes a patient with spontaneous DIHE with recurrent massive bleeding which required critical management and highlights a potential role for therapeutic angiography as an alternative to surgery. 2009 The WJG Press and Baishideng. All rights reserved.

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Author and article information

Contributors

Sachiko Ito: sachi-i@rj9.so-net.ne.jp

Shihoko Iwata: shk_wt_0204@ybb.ne.jp

Izumi Kondo: mimizu@ga2.so-net.ne.jp

Motoyo Iwade: miwade@mrj.biglobe.ne.jp

Makoto Ozaki:

ORCID: http://orcid.org/0000-0001-7841-6661

+81-3-3353-8111 , morton@live.jp

Tatsuya Ishikawa: tishikawa@twmu.ac.jp

Takakazu Kawamata: tkawamata@nij.twmu.ac.jp

Journal

Journal ID (nlm-ta): JA Clin Rep

Journal ID (iso-abbrev): JA Clin Rep

Title: Ja Clinical Reports

Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )

ISSN (Electronic): 2363-9024

Publication date (Electronic): 3 October 2017

Publication date PMC-release: 3 October 2017

Publication date (Print): 2017

Volume: 3

Issue: 1

Electronic Location Identifier: 54

Affiliations

[1 ]ISNI 0000 0001 0720 6587, GRID grid.410818.4, Department of Anesthesiology, , Tokyo Women’s Medical University, ; Tokyo, 162-8666 Japan

[2 ]ISNI 0000 0001 0720 6587, GRID grid.410818.4, Department of Neurosurgery, , Tokyo Women’s Medical University, ; Tokyo, 162-8666 Japan

Author information

Makoto Ozaki http://orcid.org/0000-0001-7841-6661

Article

Publisher ID: 124

DOI: 10.1186/s40981-017-0124-3

PMC ID: 5804650

SO-VID: c76c2666-43bf-41b1-b2fc-77933a210275

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

History

Date received : 23 August 2017

Date accepted : 26 September 2017

Custom metadata

Keywords: esophageal submucosal hematoma,coil embolization,cerebral aneurysm,antiplatelet and anticoagulant therapies,cough during tracheal extubation

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Keywords: esophageal submucosal hematoma, coil embolization, cerebral aneurysm, antiplatelet and anticoagulant therapies, cough during tracheal extubation

Esophageal submucosal hematoma developed after endovascular surgery for unruptured cerebral aneurysm under general anesthesia: a case report

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Abstract

Background

Case presentation

Conclusions

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Probing cerebral hemodynamics with BOLD fMRI

Most cited references 10

Prevention and treatment of thromboembolic and ischemic complications associated with endovascular procedures: Part II--Clinical aspects and recommendations.

Effect of antiplatelet therapy on thromboembolic complications of elective coil embolization of cerebral aneurysms.

Recurrent massive bleeding due to dissecting intramural hematoma of the esophagus: treatment with therapeutic angiography.

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