A retrospective review of patients with non-traumatic spontaneous intramural hematoma

Altıntoprak, Fatih; Dikicier, Enis; Akyüz, Muhammet; Deveci, Uğur; Arslan, Yusuf; Gündüz, Yasemin; Yücel, Murat; Dılek, Osman Nuri

doi:10.4318/tjg.2013.0697

Cited by 16 publications

(26 citation statements)

References 18 publications

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“…It is a rare cause of small bowel obstruction [2, 3]. Over 90% of cases occur secondary to blunt abdominal trauma [2].…”

Section: Discussionmentioning

confidence: 99%

“…Over 90% of cases occur secondary to blunt abdominal trauma [2]. The leading cause of non-traumatic ‘spontaneous’ intramural haematoma is supratherapeutic anticoagulation with warfarin [3]. Risk factors associated with gastrointestinal bleeding on warfarin include previous gastrointestinal bleed, advanced age, comorbidities (including atrial fibrillation, renal insufficiency and chronic liver disease) and co-administration with antiplatelet agents or medications that compete for metabolism by CYP3A4 enzymes (such as fenofibrate, as seen in this case) [4, 5].…”

Section: Discussionmentioning

confidence: 99%

“…Intramesenteric or retroperitoneal bleeding may also occur, particularly with duodenal involvement [9]. Supratherapeutic INR and leukocytosis are common; however, presence of anaemia is variable, with incidence ranging from 7.6 to 84.6% in case series [3]. …”

Section: Discussionmentioning

confidence: 99%

“…Intramural haematomas are rarely life-threatening and can predominantly be managed non-operatively [3]. As demonstrated above, the mainstay of management is early diagnosis with appropriate resuscitation, reversal of anticoagulation (including anticoagulant cessation, administration of intravenous vitamin K, prothrombinex, fresh frozen plasma or factor concentrates as required) and management of obstructive symptoms [2].…”

Section: Discussionmentioning

confidence: 99%

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Extensive small bowel intramural haematoma secondary to warfarin

Limmer

Clement

2017

Journal of Surgical Case Reports

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Intramural haematoma is a rare complication of oral anticoagulant therapy, occurring in 1 in 2500 patients treated with warfarin. This report describes a 71-year-old gentleman who presented with tachycardia, vomiting and abdominal distension on a background of anticoagulation for a metallic aortic valve. He was found to have a supratherapeutic international normalized ratio (INR) of 9.9 with an extensive small bowel intramural haematoma and secondary small bowel obstruction. He was successfully managed non-operatively with fluid resuscitation, INR reversal, bowel rest and nasogastric decompression. The patient's presentation was atypical with a lack of classic symptoms such as abdominal pain. This highlights the importance of considering intramural haematoma as a differential diagnosis for gastrointestinal symptoms in anticoagulated patients.

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“…It is a rare cause of small bowel obstruction [2, 3]. Over 90% of cases occur secondary to blunt abdominal trauma [2].…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Extensive small bowel intramural haematoma secondary to warfarin

Limmer

Clement

2017

Journal of Surgical Case Reports

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“…The PubMed were used in order to review the literature describing the case who had underwent surgical treatment by a diagnosis of intramural hematoma of small intestine from 2003 to 2016 ( Table 1 , 14cases). More seriously ill patients should tend to have surgical indication, however, recent studies present acceptably good prognosis of patients who underwent surgical therapy (out of 14 patients, 11 were discharged alive) 7,8,12,[15][16][17][18][19][20] .…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Intramural Hematoma of the Jejunum Induced by Anticoagulant Therapy

Hirosawa

Kudoh

Aoki

et al. 2018

JJCS

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A spontaneous, intramural, small-bowel hematoma requiring a surgery is a rare complication of anticoagulant therapy. We present a case of an 82-yearold man who developed abdominal pain in the setting of abnormal coagulation function related to warfarin therapy used as chronic prophylaxis against recurrent pulmonary embolism. Computed tomography (CT) showed wall thickening and luminal narrowing of the jejunum. Dilation of the small bowel proximal to the thickening was also present, indicative of small bowel obstruction. Initially, the patient was treated conservatively, but he later required laparotomy due to worsening of his general condition. A 50cm jejunal segment was resected in order to relieve the intestinal obstruction and to arrest the bleeding. For intramural, small-bowel hematoma, conservative medical management should be the first treatment of choice, but surgical intervention may be indicated if conservative treatment is not successful.

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Jejunal intramural haematoma in a captive African lion (Panthera leo)

Butcher

Lenting

Clarke

et al. 2022

Vet Record Case Reports

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A 19‐year‐old, entire, female, captive African lion (Panthera leo) presented acutely for reduced appetite and lethargy. Bloodwork revealed a poorly regenerative anaemia, hypoalbuminaemia and monocytosis. Ultrasound indicated the presence of a peri‐renal mass, but advanced imaging techniques were unavailable at the time. Minimal clinical improvement was seen with supportive treatment, and euthanasia was elected 11 days after presentation. Postmortem examination revealed an intramural intestinal haematoma of the jejunum with serosal haemorrhage and haemoabdomen, and a peri‐renal mass. Histology showed that the peri‐renal mass was an adrenal cortical carcinoma. The underlying cause of the intramural haematoma was not determined, but it was considered the probable cause for the clinical decline of this animal. Intramural intestinal haematoma is an uncommon entity in veterinary species, and has not been reported in any members of Felidae. This is the first documented case of an intramural intestinal haematoma in an African lion.

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A retrospective review of patients with non-traumatic spontaneous intramural hematoma

Abstract: Girifl ve Amaç: Non-travmatik spontan intramural hematom oldukça nadir görülen bir klinik durumdur ve en s›k nedeni afl›r› antikoagülasyondur. Bu çal›flmada; afl›r› antikoagülasyona ba¤l› olarak spontan ince barsak intramural hematom tan›s› koyulan

Cited by 16 publications

References 18 publications

Extensive small bowel intramural haematoma secondary to warfarin

Extensive small bowel intramural haematoma secondary to warfarin

Spontaneous Intramural Hematoma of the Jejunum Induced by Anticoagulant Therapy

Jejunal intramural haematoma in a captive African lion (Panthera leo)

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