Xu YL, Zhang ML, Zhou HJ, Gao PJ, Zhang XN, Rao M. Giant rectal intramural hematoma following endoscopic submucosal dissection successfully treated with conservative therapy: A case report. World J Gastrointest Endosc 2026; 18(3): 115257 [DOI: 10.4253/wjge.v18.i3.115257]
Corresponding Author of This Article
Min Rao, Department of Gastroenterology, Lequn Branch, The First Hospital of Jilin University, No. 3302 Jilin Road, Changchun 130000, Jilin Province, China. raomin@jlu.edu.cn
Research Domain of This Article
Oncology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Yan-Ling Xu, Pu-Jun Gao, Department of Hepatology, The First Hospital of Jilin University, Changchun 130000, Jilin Province, China
Man-Li Zhang, Hong-Jie Zhou, Xiu-Na Zhang, Min Rao, Department of Gastroenterology, Lequn Branch, The First Hospital of Jilin University, Changchun 130000, Jilin Province, China
Co-first authors: Yan-Ling Xu and Man-Li Zhang.
Author contributions: Xu YL and Zhang ML contributed equally to this work as co-first authors; Xu YL was the principal physician in charge of the patient’s management, collected the clinical data, and was the primary author of the manuscript; Zhang ML assisted in the endoscopic procedure, data collection, and literature review; Zhou HJ and Gao PJ participated in the patient’s clinical care and data analysis; Zhang XN contributed to the data interpretation and revision of the manuscript; Rao M supervised the entire clinical management, provided critical intellectual input, and is the corresponding author responsible for the manuscript. All authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Min Rao, Department of Gastroenterology, Lequn Branch, The First Hospital of Jilin University, No. 3302 Jilin Road, Changchun 130000, Jilin Province, China. raomin@jlu.edu.cn
Received: October 15, 2025 Revised: December 9, 2025 Accepted: January 15, 2026 Published online: March 16, 2026 Processing time: 150 Days and 23.3 Hours
Abstract
BACKGROUND
Endoscopic submucosal dissection (ESD) is a viable therapeutic approach for laterally spreading tumors; however, delayed intramural hematoma remains a rare but serious complication. This report describes a successfully managed case, adding valuable evidence to the existing literature. This study demonstrates that conservative management can be both safe and effective, despite previous reports of fatal outcomes. This experience underscores the importance of early recognition and appropriate management of this complication by endoscopists.
CASE SUMMARY
A 60-year-old male underwent ESD due to a rectal laterally spreading tumor. The procedure was completed successfully, and the initial postoperative course was uneventful. On postoperative day 4, the patient developed hematochezia accompanied by a drop in hemoglobin level. Emergency colonoscopy revealed a large intramural hematoma at the ESD site. The patient was treated with conservative therapy including bowel rest, bed rest, antibiotics, and hemostatic agents. The following day, the patient developed abdominal distension and constipation, which were managed conservatively. His condition stabilized, and hemoglobin levels remained stable. By postoperative day 15, symptoms had fully resolved. Follow-up colonoscopy showed near-complete hematoma resolution, and the patient was discharged. Six months later, a well-healed ESD scar confirmed a successful long-term outcome.
CONCLUSION
Delayed intramural hematoma following ESD can be effectively managed with conservative therapy, resulting in complete recovery.
Core Tip: This report describes a case of delayed intramural hematoma occurring on the fourth day after endoscopic submucosal dissection of a rectal laterally spreading tumor. The intramural hematoma was successfully treated non-surgically, resulting in complete recovery. In contrast to previously reported fatal outcomes, this case provides valuable clinical evidence that careful non-surgical management can achieve excellent results, highlighting an important strategy for endoscopists to avoid unnecessary invasive interventions.
