Submucosal hematoma of the esophagus due to fish bone ingestion.

Esophageal submucosal hematoma is a rarely observed condition in which abrupt bleeding occurs between the mucosa and muscularis propria of the esophageal wall, often involving a long portion of the esophagus. Possible causes of submucosal hematoma of the esophagus include external trauma, endoscopic sclerotherapy of the esophageal varices, vigorous vomiting, ingestion of a foreign body, complications of esophageal instrumentation (1) or coagulopathy or use of an anticoagulant (2). Submucosal hematomas present as acute substernal or epigastric pain and are typically accompanied by dysphagia or hematemesis. Diagnosis requires an endoscopy with a small-diameter ultrasonic probe and chest computed tomography (CT) (3).