Successful Endoscopic Fenestration for Giant Esophageal Hematoma After Failed Conservative Therapy.

We present the case of a young man with no notable medical history and who was not on anticoagulant or antiplatelet therapy but presented with chest pain shortly and melena after eating nuts. He had a large 20-cm dissecting intramural hematoma in the esophagus. Despite providing proton pump inhibitors as conservative treatment for 2 days, his chest discomfort persisted and hemoglobin level declined substantially; thus, endoscopic hematoma fenestration was performed. Repeat esophagogastroduodenoscopy 1 week postoperatively revealed substantial improvement in esophageal hematoma, with notable mucosal regeneration.