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Submucosal hematoma: a new distinctive sign during emergency upper digestive endoscopy for ammonia ingestion

  • Gelu-Simeon, Moana1, 2, 3
  • Chuong, Anh-Phuc4
  • Saliba, Faouzi5
  • Thiery, Guillaume6
  • Laurent, Marc7
  • Vilain, Claire1
  • Borel, Marius1
  • Amaral, Leonardo1
  • Alexis, Marceline1
  • Saint-Georges, Georgette1
  • Saillard, Eric1
  • 1 CHU de Pointe-à-Pitre, Service d’Hépato-Gastro-Entérologie, Route de Chauvel, Pointe-à-Pitre cedex, Guadeloupe, F-97159, France , Pointe-à-Pitre cedex (France)
  • 2 INSERM, UMR-S 1085/IRSET, Rennes, F-35043, France , Rennes (France)
  • 3 Université Antilles-Guyane, Faculté de médecine Hyacinthe Bastaraud, Pointe-à-Pitre Cedex, F-97110, France , Pointe-à-Pitre Cedex (France)
  • 4 CHU de Saint-Pierre, Service d’Hépato-Gastro-Entérologie, Saint-Pierre Cedex, La Réunion, F-97448, France , Saint-Pierre Cedex (France)
  • 5 Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Villejuif, F-94800, France , Villejuif (France)
  • 6 CHU de Pointe-à-Pitre, Service de Réanimation, Pointe-à-Pitre, Guadeloupe, F-97139, France , Pointe-à-Pitre (France)
  • 7 CHU de Saint-Denis, Service d’Hépato-Gastro-Entérologie, Saint-Denis, La Réunion, F-97405, France , Saint-Denis (France)
Published Article
BMC Gastroenterology
Springer (Biomed Central Ltd.)
Publication Date
Jun 20, 2018
DOI: 10.1186/s12876-018-0809-8
Springer Nature


BackgroundSubmucosal hematoma has never been associated with caustic injuries. Long-term follow-up of patients who ingested ammonia is not well known and ammonia ingestion is rare.MethodsIn a Single-center observational study, prospective data were collected from 2009 to 2013, in patients over the age of 14 years old referred for ammonia ingestion. The emergency and follow-up endoscopic data and the outcome were reported.ResultsAmmonia ingestion occurred in 43 patients. Submucosal hematoma of the gastric wall was a distinctive endoscopic sign observed in 15 (34.8%) cases. Oropharyngeal lesions were present in 30 (69.8%) patients, which was associated with ingestion with suicidal intent in 18 cases. Mild and severe endoscopic lesions (grade IIB to IIIB) were found in 16 (37.2%) cases with 10 (23.3%) cases presenting submucosal hematoma at initial endoscopy. A complete spontaneous gastric healing was frequently observed in 36 (83.7%) cases. In 11 cases with submucosal hematoma, a favourable outcome was observed with a medical treatment, however 6 of these patients had severe endoscopic lesions initially.ConclusionsSubmucosal hematoma of the gastric wall is an endoscopic sign occurring frequently in ammonia ingestion. Submucosal hematoma should be distinguished from necrosis in order to avoid false misclassification in favour of more severe lesions, which would lead to an abusive surgery.

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