Sonographic diagnosis of spontaneous intramural small bowel hematoma in a case of warfarin overdose

Abstract

A 38-year-old man who had been treated with warfarin since mitral valve replacement 10 years earlier presented with acute onset of epigastralgia and melena. Coagulation tests were abnormal with a prolonged prothrombin time of >60 seconds and a prolonged activated partial thromboplastin time of >120 seconds. Abdominal sonographic examination revealed duodenal intramural hematoma that was confirmed on CT. Warfarin therapy was stopped and the patient was treated conservatively with vitamin K and fresh frozen plasma. Recovery was uneventful, and the patient was re-warfarinized 2 weeks later. Duodenal hematoma can be readily diagnosed with bedside sonography.

Spontaneous intestinal intramural hematoma: What to do and not to do

“…Intestinal intramural hematoma is located in the duodenum especially in children, whereas spontaneous intramural hematoma is often seen in the jejunum. Hemorrhagic complications of anticoagulant medications are hematuria, gastrointestinal hemorrhage, intracerebral hemorrhage, soft tissue hematoma, epistaxis, and retroperitoneal hematomas (1). Bleeding as intramural hematoma of the small intestine is rare, seen in 1 out of 2500 patients (2).…”

“…Other risk factors are hemobilia, idiopathic thrombocytopenic purpura, leukemia, lymphoma, myeloma, chemotherapy, vasculitis, pancreatitis, and pancreatic cancer (3,4). Conditions requiring surgery are serious intraluminal bleeding, bowel perforation or the presence of ischemia (1,2). If diagnosis can be confirmed, conservative treatment with correction of coagulation parameters is satisfactory in most cases (5).…”

A Rare Cause of Intestinal Volvulus: Spontaneous Intramural Hematoma of Small Intestine

“…Intra-peritoneal hemorrhagic effusion, when present, is related to the leakage of blood from an enlarged, thickened and inflamed bowel wall with submucosal bleeding into all layers [3][4][5]. Clinical presentation can vary from mild, vague abdominal pain to intestinal obstruction and an acute abdomen [6,7]. Our patient displayed an acute abdomen with widespread abdominal defense.…”

Warfarin Therapy Induced a Rare Complication: Spontaneous Intramural Hematoma of the Jejunum: Case Report

“…9 In a study, Abdel Samie and Theilman reported a case of intramural hematoma in four patients who received an anticoagulant (phenprocoumon) due to atrial fibrillation. Of these, 2 were localized in the jejunum, whereas 1 in the duodenum and 1 in the rectum.…”