jksr Journal of the Korean Society of Radiology J Korean Soc Radiol 1738-2637 2288-2928 The Korean Society of Radiology 10.3348/jksr.2019.80.1.117 jksr-80-117 Case Report Intramural Gastric Hematoma after AcuteNecrotizing Pancreatitis: A Case Report and Reviewof Imaging Findings LeeJinhwanMD 1 ParkSo HyunMD 1 ∗ ChoiSeung JoonMD 1 AhnSu-JoaMD 1 KimHyung-SikMD 1 KimYeon SukMD 2 ShimYoungsupMD 1 Department of Radiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea Department of Internal medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea Corresponding author So Hyun Park, MD Department of Radiology, Gil Medical Center, Gachon University College of Medicine, 21 Namdong-daero 774beon-gil, Namdong-gu, Incheon 21565, Korea. Tel 82-32-458-2676 Fax 82-32-460-3065 E-mail nnoleeter@naver.com 01 2019 20 01 2019 80 1 117 121 12062018 12072018 25072018 Copyright © 2019 The Korean Society of Radiology 2019 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract

Intramural hematoma of the gastrointestinal tract is a rare disease entity. Pancreatitis-induced intramural gastric hematoma (IGH) is far more seldom reported. Here, we report a rare case of a giant IGH occurring as a delayed complication of pancreatitis in a 51-year-old man. The diagnosis was made using computed tomography (CT) and endoscopic ultrasonography. The patient was conservatively managed, and follow-up abdominal CT showed marked decreases in the size of the IGH.

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A 51-year-old man with an IGH associated with pancreatitis. A–C. Axial CT scans showing a mixture of fluid-dense and hyperdense lesions (50–70 Hounsfield units) (A) without enhancement (white arrows) and (B) along the greater curvature of the stomach (black arrows). (C) Coronal CT scan showing a huge hematoma (white arrowheads) along the gastric wall and distension of the gastric wall. There is a small amount of fluid collection with mild peritoneal thickening in the omentum and perisplenic space, suggesting remnant or recurrent walled-off necrosis of pancreatitis. D. A small tubular structure (arrow) between the pancreatic tail and IGH, suggesting the possible presence of a pancreaticogastric fistula. E. Endoscopic ultrasonography shows a large cystic lesion with heterogeneous echogenicity and internal septation in the greater curvature of the gastric wall. There was no vascularity within the mass. About 200 mL of fluid was aspirated. As the fluid appeared dark reddish in color,the mass was confirmed as a hematoma. F. Follow-up abdominal CT scan obtained after about 2 months showing a marked decrease in the size of IGH, and walled-off necrosis around the pancreas tail and retroperitoneum.