To the Editor.—
Upper gastrointestinal bleeding is a common clinical entity that occasionally presents in a manner so unusual as to obscure the correct diagnosis. This is true for intramural esophageal hematoma, an uncommon presentation of bleeding that has been recognized in several clinical settings.1,2 We present the case of an elderly woman with upper gastrointestinal bleeding associated with intramural esophageal hematoma related to pill-induced esophageal injury.
Report of a Case.—
An 81-year-old woman presented because of chest pain of sudden onset, associated with nausea and vomiting of bright red blood. The patient had hypertension treated with a diuretic and had been given tryptophan for "depression and insomnia." The evening before admission, she took two tryptophan tablets before retiring. She swallowed the first tablet with relative ease but felt the second tablet stick in her midchest. Later that night, she awoke with an intense, burning sub-xiphoid pain that penetrated
Piccione PR, Winkler WP, Baer JW, Kotler DP. Pill-Induced Intramural Esophageal Hematoma. JAMA. 1987;257(7):929. doi:10.1001/jama.1987.03390070049018