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

• Published in: BMC gastroenterology Vol. 18; no. 1; p. 92
• Main Authors: Gelu-Simeon, Moana, Chuong, Anh-Phuc, Saliba, Faouzi, Thiery, Guillaume, Laurent, Marc, Vilain, Claire, Borel, Marius, Amaral, Leonardo, Alexis, Marceline, Saint-Georges, Georgette, Saillard, Eric
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 20-06-2018; BioMed Central; BMC
• Subjects: Abdomen; Adolescent; Adult; Aged; Aged, 80 and over; Ammonia; Ammonia - adverse effects; Ammonium hydroxide; Ammonium Hydroxide - adverse effects; Analysis; Aqueous ammonia solution; Caribbean island; Caustic ingestion; Caustics - adverse effects; Classification; Diagnosis, Differential; Endoscopy; Endoscopy, Digestive System; Epidemiology; Esophagus; Female; Gangrene; Gastric Mucosa - pathology; Gastroenterology; Gastrointestinal Hemorrhage - chemically induced; Gastrointestinal Hemorrhage - drug therapy; Gastrointestinal Hemorrhage - pathology; Health aspects; Hematoma; Hematoma - chemically induced; Hematoma - drug therapy; Hematoma - pathology; Hospitals; Humans; Injuries; Life Sciences; Male; Middle Aged; Necrosis; Nutrition research; Pain; Patients; Prospective Studies; Proton Pump Inhibitors - therapeutic use; Santé publique et épidémiologie; Submucosal hematoma; Suicide, Attempted; Surgeons; Tomography; Treatment outcome; Young Adult; Guadeloupe; Caustic ingestion; Submucosal hematoma; Caribbean island; Aqueous ammonia solution; Ammonium hydroxide
• ISSN: 1471-230X; 1471-230X
• DOI: 10.1186/s12876-018-0809-8

Submucosal 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.
In 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.
Ammonia 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.
Submucosal 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.