Advertisement

Clinical Journal of Gastroenterology

, Volume 4, Issue 6, pp 387–390 | Cite as

Anticoagulant-induced intramural hematoma of the jejunum

  • Preetinder Brar
  • Iqbal Singh
  • Supreet Kaur
  • Rudra Prasad Doley
  • Rahat Brar
  • Arvind Sahni
  • Jai Dev WigEmail author
Case Report

Abstract

Background

Spontaneous intramural intestinal hematoma in patients on oral anticoagulation therapy is rare.

Materials and methods

Case report.

Results

We report a spontaneous intramural jejunal hematoma presenting with small bowel obstruction in a patient who was on oral anticoagulation therapy with acitrom following aortic valve replacement. Contrast-enhanced computed tomography of the abdomen showed findings of intramural hematoma. The patient was successfully managed conservatively.

Conclusion

Abdominal pain and abnormal coagulation profile in patients on oral anticoagulants should alert the clinician to consider intramural hematoma. Early diagnosis is essential, as patients are successfully managed conservatively with good outcome.

Keywords

Intramural hematoma Jejunum Acitrom International normalized ratio (INR) 

Notes

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Fukumaga N, Ishikawa M, Yamamura Y, Ichimori T, Sakata A. Spontaneous intramural duodenal hematoma complicating acute pancreatitis. Surgery. 2011;149:143–4.CrossRefGoogle Scholar
  2. 2.
    Tseng C-Y, Fan J-S, Yang S-C, Huang H–H, Chen J-D, H-T Yen D, Huang C-I. Anticoagulant induced intramural intestinal haemorrhage. Am J Emerg Med. 2010;28:937–40.PubMedCrossRefGoogle Scholar
  3. 3.
    Veldt B J, Haringsma J, Florijn KW, Kuipers EJ. Coumarin-induced intramural hematoma of the duodenum: case report and review of the literature. Scand J Gastroenterol 2011; 46: 376--379.Google Scholar
  4. 4.
    Manu N, Martin L. Warfarin induced small bowel obstruction. Clin Lab Haematol. 2005;27:350–2.PubMedCrossRefGoogle Scholar
  5. 5.
    Dos Santos MM, Rodrigues R, Tafarel J, Nakao F, Ferrari A, Libera E. Spontaneous colonic hematoma: endoscopic appearance. Dig Endosc. 2007;19:97–9.CrossRefGoogle Scholar
  6. 6.
    Dhawan V, Mohamed A, Fedorak RN. Gastric intramural hematoma: a case report and literature review. Can J Gastroenterol. 2009;23:19–22.PubMedGoogle Scholar
  7. 7.
    Chaiteerakij R, Treeprasertsuk S, Mahachai V, Kullavanijaya P. Anticoagulant-induced intramural intestinal hematoma: report of three cases and literature review. J Med Assoc Thai. 2008;91:1285–90.PubMedGoogle Scholar
  8. 8.
    Polat C, Dervisoglu A, Guven H, Kaya E, Malazgirt Z, Danaci M, et al. Anticoagulant-induced intramural intestinal hematoma. Am J Emerg Med. 2003;21:208–11.PubMedCrossRefGoogle Scholar
  9. 9.
    Abbas MA, Collins JM, Olden KW. Spontaneous intramural small-bowel hematoma: imaging findings and outcome. Am J Roentgenol. 2002;179:1389–94.Google Scholar
  10. 10.
    Palareti G, Leali N, Coccheri S, Poggi M, Manotti C, D’Angelo A, et al. Bleeding complications of oral anticoagulant treatment: an inception-cohort prospective collaborative study (ISCOAT). Italian Study on Complications of Oral Anticoagulant Therapy. Lancet. 1996;348:423–8.PubMedCrossRefGoogle Scholar
  11. 11.
    Schulman S. Care of patient receiving long term anticoagulation therapy. N Engl J Med. 2003;349:675–83.PubMedCrossRefGoogle Scholar
  12. 12.
    Ho MP, Tsai KC, et al. Spontaneous intramural small bowel hematoma associated with warfarin nonadherence in an elderly patient. J Am Geriatr Soc. 2010;58:608–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Herbert DC. Anticoagulant therapy and the acute abdomen. Br J Surg. 1968;55:353–7.PubMedCrossRefGoogle Scholar
  14. 14.
    Quintero AM, Gaviria M, Balparda JK, Cuervo HR. Intramural esophageal hematoma secondary to coumarinic anticoagulation: a case report. Cases J. 2009;2:9368. doi: 10.1186/1757-1626-2-9368.PubMedCrossRefGoogle Scholar
  15. 15.
    Hsiao CW, Chao PC. Warfarin-induced intramural haematoma of the ileocecal valve with obstruction. ANZ J Surg. 2004;74:810–1.PubMedCrossRefGoogle Scholar
  16. 16.
    Abbas MA, Collins JM, Olden KW. Spontaneous intramural small bowel hematoma. Clinical presentation and long term outcome. Arch Surg. 2002;137:306–10.PubMedCrossRefGoogle Scholar
  17. 17.
    Green BT, Tendler DA. Ischemic colitis: a clinical review. South Med J. 2005;98:217–21.PubMedCrossRefGoogle Scholar
  18. 18.
    Zou X, Cas J, Yao Y, Liu W, Chen L. Endoscopic findings and clinicopathologic characteristic of ischemic colitis: a report of 85 cases. Dig Dis Sci. 2009;54:2009–15.PubMedCrossRefGoogle Scholar
  19. 19.
    Stamatakos M, Douzinas E, Stefanaki C, Petropoulau C, Arampatzi H, Safioleas C, Giannppoulous G, et al. Ischemic colitis: surging waves of update. Tohuku J Exp Med. 2009;218:83–92.CrossRefGoogle Scholar
  20. 20.
    Yu J, Kim B, Chung S, Park C W, Chang YS. Ischemic enteritis in a patient with chronic renal failure: diagnosis and management decisions. BMJ Case Rep 2010. doi: 10.1136/bcr.2009.2249.
  21. 21.
    Macari M, Chandarana H, Balthazar E, Babb J. Intestinal ischemia versus intramural hemorrhage: CT evaluation. Am J Roentgenol. 2003;180:177–84.Google Scholar
  22. 22.
    Jans L, De Backer A, Fransen H, Dewilde D, Lemmerling M, Verstraete K. Spontaneous intramural small-bowel hematoma. JBR-BTR. 2006;89:102.PubMedGoogle Scholar
  23. 23.
    Birla RP, Mahawar KK, Saw EYW, Tabaqucholi MA, Woolfall P. Spontaneous intramural jejunal hematoma: a case report. Cases J. 2008;1:389. doi: 10.1186/1757-1626-1-389.PubMedCrossRefGoogle Scholar
  24. 24.
    Baglin TP, Keeling DM, Watson HG. Guidelines on oral anticoagulation (warfarin): third edition—2005 update. Br J Haematol. 2006;132:277–85.PubMedCrossRefGoogle Scholar
  25. 25.
    Ananthasubramaniam K, Beattie JN, Rosman HS, Jayam V, Borzak S. How safely and for how long can warfarin therapy be withheld in prosthetic heart valve patients hospitalized with a major hemorrhage? Chest. 2001;119:478–84.PubMedCrossRefGoogle Scholar

Copyright information

© Springer 2011

Authors and Affiliations

  • Preetinder Brar
    • 1
  • Iqbal Singh
    • 1
  • Supreet Kaur
    • 1
  • Rudra Prasad Doley
    • 1
  • Rahat Brar
    • 2
  • Arvind Sahni
    • 3
  • Jai Dev Wig
    • 1
    Email author
  1. 1.Department of General SurgeryFortis HospitalMohaliIndia
  2. 2.Department of RadiodiagnosisFortis HospitalMohaliIndia
  3. 3.Department of GastroenterologyFortis HospitalMohaliIndia

Personalised recommendations