A rare cause of hematemesis: Esophageal haematoma as a complication of subclavian puncture

A 52-year-old female patient with chronic renal failure was admitted to the emergency unit with hematemesis and hypotension. She's been on haemodialysis for three years and a catheter insertion via the subclavian vein had been attempted without success some hours before ad- mission. The patient had subcutaneous haematoma on the right side of the neck and chest wall (Figure 1), hy- potension and tachycardia. Haemoglobin level was 7.5 g/dl, platelets and coagulation parameters were within normal range. oesophagogastroduodenoscopy revealed that nearly the whole oesophageal lumen was filled with intramural haematoma and there was blood in stomach (Figure 1). Haematoma was on the right wall and ex- tending to the esophagogastric junction and cardia (Fi- gure 1). There wasn't any active bleeding so the patient didn't need any intervention. CT scan showed that the haematoma was restricted within submucosa of oesopha- gus and that there wasn't any sign of vascular association or active bleeding. Subsequent endoscopic evaluations showed that haematoma improved without any compli- cations. The patient was then followed up as outpatient and at the end of three weeks, endoscopy revealed com- plete resolution of haematoma with normal esophageal mucosa (Figure 1).