Hematoma in the Stomach: Rare but Possible After Trauma or Surgery

A hematoma is a localized collection of blood outside vessels. While intramural gastric hematoma (within stomach wall) is rare, it can occur from:

• Blunt abdominal trauma
• Anticoagulation (warfarin, DOACs) + minor injury
• Endoscopic procedures (biopsy, polypectomy, EMR/ESD)
• Gastric surgery
• Bleeding disorders

Presentation

• Epigastric pain, nausea, vomiting
• Possible upper GI bleeding if erodes into lumen
• Palpable mass (if large)

Diagnosis & Management

• CT with contrast: shows intramural hematoma (crescentic, non-enhancing).
• Endoscopy: may see submucosal mass with blue discoloration.
• Conservative: observation, transfusion if needed, reverse anticoagulation, PPI.
• Surgery/embolization: if expanding, hemorrhaging, or compressing structures.

Distinct from gastric varices, tumors, or pseudoaneurysms. Requires high clinical suspicion.